Risks/benefits of telling OB about homebirth - Mothering Forums

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#1 of 23 Old 06-22-2011, 02:18 PM - Thread Starter
 
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We are planning a homebirth for our second baby due this August. I am also seeing an OB just in case. (My HMO says that if I deliver at a hospital, I will need to have had a relationship established with an OB to be covered, etc etc)

 

Anyway, I have not yet broken the news to my OB that we are planning a HB. I've read lots of stories where the moms have been "fired" by their OB when they found out about the homebirth. Seems a pretty big risk to take to me. I don't know what I'd do if my OB dropped me and I was left with no OB/hospital backup. That said, my OB HAS worked with a birth center before and has been known to respect the mom's choice on where to birth, including at home. But still... I'm ultra paranoid.

 

Are there any moms out there who can share either a positive or negative experience with telling their OB's about a homebirth? and what, exactly, are the benefits of doing so when it seems the risk of being dropped is just too great?

 

Thanks in advance for helping me think through this...

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#2 of 23 Old 06-22-2011, 07:38 PM
 
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Personally, I don't see the reason for shadow care or backup OBs when you're planning a HB. If your insurance requires you to have an established relationship, then ok (though that sounds weird to me), but in that case it sounds like you've established one! Why not just stop going? No need to "break up" or explain yourself; just don't make another appointment! I'd certainly *not* tell him/her you're planning a HB; I just don't see what good would possibly come of that (and I can imagine plenty of problems, no matter how "natural birth-friendly" they claim or seem to be).
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#3 of 23 Old 06-22-2011, 07:58 PM - Thread Starter
 
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Personally, I don't see the reason for shadow care or backup OBs when you're planning a HB. If your insurance requires you to have an established relationship, then ok (though that sounds weird to me), but in that case it sounds like you've established one! Why not just stop going? No need to "break up" or explain yourself; just don't make another appointment! I'd certainly *not* tell him/her you're planning a HB; I just don't see what good would possibly come of that (and I can imagine plenty of problems, no matter how "natural birth-friendly" they claim or seem to be).


These are exactly my sentiments. I am just questioning myself because my midwife is recommending that I at least "feel him out" (my OB) to see where he stands. If he reacts with support, then a-okay. But if he gets all negative, then don't let on with any more details... I just am not sure why she's even saying to bother...  I just don't see any benefits to telling him. Does anyone else??

 

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#4 of 23 Old 06-22-2011, 08:35 PM
 
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I had a positive experience - but I also had a family physician instead of an OB which I think makes things a little different.  A few of his own kids were delivered at home - so I knew he was not against homebirth.  However, the medical system in which he practices is very anti-homebirth and he couldn't even put my plan to homebirth in my records or officially say that he was my backup to a homebirth, nor could he ever communicate with my CPM.  The benefit to telling him for me was that I could have an honest discussion with him whenever there were concerns. I am not a good liar and I would have been extremely uncomfortable having fake conversations with him about the delivery and birth plans.

 

There are some good benefits to having shadow care and backups but it is also dependant on the homebirth climate in your state and your own situation.  [If I live in a friendly homebirth state, I would not really see much of a need for shadow care.]  In my case, the medical community is not very friendly to homebirth and if I ever had to transfer care or transfer for delivery, I wanted it to be with someone that I trusted -this was very important to me (but it may not be for others). I had shadow care by my family physician and it was extremely helpful to me - he was able to order tests easily, do in office u/s to check position when baby was breech and vertex at 37-38 weeks and perscribe abx for my multiple UTIs (which my CPM could not do). He was also my backup plan if the baby was breech (he would deliver a vaginal breech and my midwife would not) and if I risked out of a homebirth at any time (GD or pre-e), he would continue my care and guarantee he would be there for delivery.  I did not go to all the regularly scheduled appointments with him (basically went about once a month and a couple extra times near the end when baby was breech) as I was already getting more than adequate prenatal care with my midwife.

 

It is easy enough to keep the relationship without telling your ob the whole truth - you could just cancel some appointments or space them out a bit more.  Or you could just keep on with shadow care and never say anything and call later to say that you had the baby at home or out-of-town.


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#5 of 23 Old 06-23-2011, 09:41 AM - Thread Starter
 
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Or you could just keep on with shadow care and never say anything and call later to say that you had the baby at home or out-of-town.



How lucky you were/are to have such a great family doc! And one with homebirthed children, to boot! What state are you in? Sounds exactly how I wish my relationship were with my OB! But, in the end, I am leaning towards doing what you stated above... 

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#6 of 23 Old 06-23-2011, 05:16 PM
 
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OP, I could have written your exact post! Except for me, I already know that my OB is definitely against HBs so I'm choosing not to say anything. I'm also trying to figure out if I should stop going to double visits, but I just told myself that I'll stop going to my OB visits as soon as soon as they don't work for me anymore. I'm lucky in that I get to see the Nurse Practitioner (who I LOVE) for my pre natal visits at his office, so that's good for me.

 

Just remember that if your OB finds out and decides to "fire" you, you still have the legal right to show up at any hospital during labor and cannot be denied care. And although it would be great to be open with your OB about your plans, you still have to do what's right for you and your baby, so I say to trust your gut.


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#7 of 23 Old 06-24-2011, 09:31 AM - Thread Starter
 
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OP, I could have written your exact post! Except for me, I already know that my OB is definitely against HBs so I'm choosing not to say anything. I'm also trying to figure out if I should stop going to double visits, but I just told myself that I'll stop going to my OB visits as soon as soon as they don't work for me anymore. I'm lucky in that I get to see the Nurse Practitioner (who I LOVE) for my pre natal visits at his office, so that's good for me.

 

Just remember that if your OB finds out and decides to "fire" you, you still have the legal right to show up at any hospital during labor and cannot be denied care. And although it would be great to be open with your OB about your plans, you still have to do what's right for you and your baby, so I say to trust your gut.


True, I cannot be denied care, but the other question is... will my insurance company cover it? Getting stuck with a $10k+ hospital bill is NOT something we can handle. ugh.

 

Agree with you... wondering when I should stop going to double visits. I still have to pay a copay for each visit, so it's costing me money, too! Just to get weighed, my belly measured, and pee in a cup. Sheesh! 

 

and yes... good advice to trust my gut... hasn't steered me wrong so far ;)  And hey! We are both due in August! I am sending you healthy, strong, peaceful pregnancy, baby, and birthing vibes... hug.gif

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#8 of 23 Old 06-24-2011, 10:00 AM
 
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I did not tell my OB until the day after DD was born. I felt as though she didnt need to know. A homebirth is not a guarantee so I figured I might as well just act as though either might happen and keep both options very open. I had a VBAC though, and so to me the OB backup was a bit more of a need.


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#9 of 23 Old 06-24-2011, 10:33 AM
 
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Similar to jumpmama, I am planning an HBAC so I really feel like I need a backup option. All of the homebirth midwives I interviewed advised me not to tell my OB I was planning a homebirth because it puts the OB in a difficult situation from a liability standpoint (because of the malpractice insurance carriers in California and various caselaw). I told my OB that I wanted a vbac, I wanted to labor at home as long as possible, and that I was hiring a midwife to help me labor at home. I think that might have given her a clue, but she was very supportive of all of it (she only said they would "like" me to come in when I got around 6-7cm dilated). I was really uncomfortable not being totally open with her in the beginning, but I realize it is as much to protect her as me. I don't really like the double appts though and not sure what to do about that. I'm only at 13 weeks so still figuring that out.

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#10 of 23 Old 06-24-2011, 11:10 AM
 
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True, I cannot be denied care, but the other question is... will my insurance company cover it? Getting stuck with a $10k+ hospital bill is NOT something we can handle. ugh.

 

Agree with you... wondering when I should stop going to double visits. I still have to pay a copay for each visit, so it's costing me money, too! Just to get weighed, my belly measured, and pee in a cup. Sheesh! 

 

and yes... good advice to trust my gut... hasn't steered me wrong so far ;)  And hey! We are both due in August! I am sending you healthy, strong, peaceful pregnancy, baby, and birthing vibes... hug.gif

 

Have you tried calling your insurance company to ask about the coverage? You should be able to ask questions about your coverage without it going on your medical record. That's what I did, and found out that all my coverage is the same regardless.

 

Thanks for the birthy vibes, I simultaneously dread August and can't wait for it to come! I haven't seen you around the August DDC, you should "stop by!"

 


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#11 of 23 Old 06-24-2011, 11:11 AM
 
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Yuck, I hate how so many women have to be so sneaky just to get their proper care!  Makes me sick


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#12 of 23 Old 06-24-2011, 08:23 PM
 
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How lucky you were/are to have such a great family doc! And one with homebirthed children, to boot! What state are you in? Sounds exactly how I wish my relationship were with my OB! But, in the end, I am leaning towards doing what you stated above... 

 

 



I am in Maine and yes, I am lucky and very grateful that there are some good docs out there.  They really deserve our support as they take a lot of flack for beleiving in their patients more than their insurance company ratings.

 


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#13 of 23 Old 06-24-2011, 08:25 PM
 
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Yuck, I hate how so many women have to be so sneaky just to get their proper care!  Makes me sick



yeahthat.gif  The medical system, especially concerning women's health and birth, is so broken.  It does not have to be this way.

 


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#14 of 23 Old 06-27-2011, 05:18 PM
 
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OP, I was in the same boat. HMO, too. I saw an OB just to have "established care" and also because my ultrasounds and any tests I wanted were covered through my OB and HMO. I wanted there to be record with the insurance company that I had prenatal care with them (even though I only went to 1 actual prenatal visit, minus the couple of ultrasounds). I told my OB from the beginning about my homebirth plans. It was a positive experience. She was not supportive of homebirthing, and she made that clear at our limited visits. I'm not fearful of confrontations, though, so I didn't mind standing my ground. I'm very educated about birth and I think she was a bit surprised by that. Since it's an HMO, they can't fire you for any reason.

 

I remember my OB touching my belly for two seconds when I went in for a quick ultrasound to rule out breech (midwife just wanted to be sure because she heard heart tones in two different areas) and she said that she was sure my baby was already over 8lbs at 34 weeks! OMG! I better be careful homebirthing such a huge baby! *gasp* It was great to email her after my perfect homebirth and tell her that my baby was born on her actual guess date at WHOLE 7lbs 2oz. orngtongue.gif

 

The main reason I decided to be upfront about it is because I wanted to normalize it for her somewhat. She said I was the first of her patients to ever home birth. Where I live, I doubt that's true. I think others just weren't upfront about it.

 

 

 

 

 

 


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#15 of 23 Old 06-28-2011, 04:23 PM
 
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Seriously, what is this world coming to? OB's are DOCTORS. They are supposed to do their jobs and CARE FOR PATIENTS NO MATTER WHAT! Who cares if it's a homebirth transfer? At least they CAME to the hospital after realizing something was wrong.

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#16 of 23 Old 06-29-2011, 08:25 AM
 
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OP, I was also in your same boat.  I decided to be upfront with all of my HCP's about my HB plans, mostly for the same reason as the PP who said that she wanted to normalize it.  I wanted the HCP's to be able to treat it as a legitimate option, so I just stood my ground when they fought with me -- then informed them that I would be transferring care to someone who would respect my choices about birthing.  I transferred care a LOT during pregnancy.  I actually saw something like eight different practitioners while I was pregnant (though, to be fair, there were other reasons for that besides the HB issue). 

 

What I did was, I called the HMO directly, and just kept asking a lot of questions that bewildered them and made them transfer my call all around the whole institution.  Questions like, "how do I get my homebirth covered?" and "which of your covered hospitals will provide facilities for my waterbirth?" and "can you provide a list of the midwives in your practice?"  I knew perfectly well that they did not cover homebirth, none of their hospitals did waterbirth, and most of them acted like they'd never heard of a midwife.  But asking the questions in that way made it clear that the lack of appropriate maternity services for natural childbirth was their problem, not mine, and they started working on bending over backwards to get me the answers -- and care -- that I wanted.  This took a lot of time and headaches, but by talking to a lot of nurses, etc., I finally tracked down a sympathetic OB within the HMO. 

 

This OB wasn't "allowed" to officially support my HB, of course, but I informed him from the beginning that I was planning a HB, had already hired a MW, and would be hiring him for shadow care, so he had all that information.  Because he was within the HMO, he couldn't "drop" me, even if he wanted to.  I think that's likely going to be true for you, too.  I decided to keep all my double appts. because DH wanted me to, which was exhausting, and in hindsight, totally unnecessary.  The OB did not ask me to schedule as many appts., however, because he knew I was seeing the MW, too.  So that was good.  You can probably convince your OB to do the same -- especially if, as you say, your OB has a reputation for supporting women's birth options. 

 

Okay, this post is getting way too long, but here's the meat of it -- I was VERY VERY glad I kept my OB for shadow care, and that I was honest with him about my HB plans.  Here's why:

He came in AT SIX IN THE MORNING, ON HIS DAY OFF to attend my birth, and the hospital respected my choices and followed my birth plan even though they are NOT a natural birth - friendly hospital AT ALL. 

  • the HMO paid for some of the prenatal testing I wanted but HB MW wouldn't/couldn't do (GD testing, GBS testing, ultrasound, etc.)
  • I was able to run my birth plan by him and have him sign off on it and place it in my file with the HMO and hospital
  • I was able to develop a trusting relationship with this OB and was honest with him about my terror of going to the hospital.  He actually gave me his personal pager number, and asked my HB MW to call him directly if I was transferring (HMO docs NEVER EVER do this, it was amazing)
  • I ended up with a non-emergent transfer after an extremely long labor at home, and because the OB had a) signed off on my birth plan and put it on file as "doctor's orders," b) given me his number, and c) known that I was terrified of a transfer, I was able to have a really good experience at the hospital. 

 

Had I not been honest with my OB, and not established full prenatal care with him, I would not have had the (fairly) positive experience at the hospital that I did.  I was VERY grateful that I had done all the extra work to get there, because had I ended up at that hospital and gottend stuck with the doc on-call, I am certain he would have sectioned me just to punish me for attempting a HB.  He was a horror movie in person, seriously.  My OB stepped in and protected me from a LOT of garbage at the hospital, and served as my advocate when I needed him the most.  And he really went way above and beyond the requirements of his job to do it. 

 

Yeah, paying for and going to all the extra appts. sucked, and it took a lot of work to be able to get everything in place that I wanted, but in the end, it was worth every minute and penny to have that birth experience go well even with a transfer as part of the picture. 

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#17 of 23 Old 07-02-2011, 09:12 AM
 
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I told my OB my plan to HB, and it was fine. He did write in my chart something about "strongly counceled against plan to HB", but I honestly think it was more a CYA move so he wouldn't be liable. I did have to sit through about ten minutes of "why hospital is the safest place" and another ten minutes of "I really hope you will transfer if" but I was fine with that. He said he hoped I would feel comfortable enough with him to seek help at any point if I felt I needed it. He mentioned post partum issues, stiching tears, etc., and said his main concern about HB is patients not getting medical help when needed.

Honestly, i would do shadow care again in a heartbeat. I had an emergency transfer after the birth due to retained placenta and severe PPH. I came in by ambulance and the hospital was able to pull my blood type, prenatal records, etc. up instantly in their system. Since I was bleeding severly, it was wonderful to not be answering questions like weight, age, EDD, and so on in a true emergency situation. They had the information they needed to treat me immediately.

Obviously, I didn't have a c/s, but I also liked shadow care because if for some reason I needed to go under the knife my OB would come in to do the surgery. Not all OBs do that, but mine does. That meant a lot to me as I really fear c/s and being able to trust the surgeon cutting me is huge for me personally.

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#18 of 23 Old 07-05-2011, 02:28 PM - Thread Starter
 
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Thanks for the birthy vibes, I simultaneously dread August and can't wait for it to come! I haven't seen you around the August DDC, you should "stop by!"

 


Oh! I hadn't thought to stop by there, thanks for the reminder. I'm definitely up for some camaraderie and support! grouphug.gif

 

 

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The main reason I decided to be upfront about it is because I wanted to normalize it for her somewhat. She said I was the first of her patients to ever home birth. Where I live, I doubt that's true. I think others just weren't upfront about it.

 

 

This is totally a reason I'd want to tell my OB. To normalize it. However... I just can't bring myself to do it before I give birth! Definitely after. One of my midwives suggested sending a thank you note to my OB after the fact... to show gratitude for his attention and care and to let him know that baby and mama are doing well after their HOMEBIRTH. winky.gif


 

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Seriously, what is this world coming to? OB's are DOCTORS. They are supposed to do their jobs and CARE FOR PATIENTS NO MATTER WHAT! Who cares if it's a homebirth transfer? At least they CAME to the hospital after realizing something was wrong.


yeahthat.gif


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Honestly, i would do shadow care again in a heartbeat. I had an emergency transfer after the birth due to retained placenta and severe PPH. I came in by ambulance and the hospital was able to pull my blood type, prenatal records, etc. up instantly in their system. Since I was bleeding severly, it was wonderful to not be answering questions like weight, age, EDD, and so on in a true emergency situation. They had the information they needed to treat me immediately.
 


nod.gif  This is why I'm not too bitter about shadow care. Yeah, it sucks having to pay for the prenatals (our "HMO" requires a copay with every prenatal visit), but I'm all about being prepared just in case. What a scary thing to have to go through! So glad it worked out smoothly for you.

 

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#19 of 23 Old 07-06-2011, 10:17 AM
 
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I'm one of those moms that have been fired by their OB. I had a copy of my records sent to the midwife on Friday, the next day I signed for a certified letter from the OB/GYN group that fired me from their practice. I am not allowed to use their practice ever again for anything. Since, this will most likely be my last baby, I will just have either find another GYN or go to my family practice for my annual exams.

 

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I've read lots of stories where the moms have been "fired" by their OB when they found out about the homebirth.

 

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#20 of 23 Old 07-08-2011, 06:34 AM
 
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Is there a way that you can see an OB that works with/is in favor of homebirthing?

My clients can be very forthright with the OB who is my supervising OB, as he is strongly in favor of homebirthing, and is in favor of HBACs after one low transverse c-sec, and is fine w homebirth after mroe than one c-sec, as long as one vaginal was at hospital, first.

Other OBs in my practice area (2 hours around Hickory, NC-my main office location) are also generally supportive, esp. one only 1/2 hour from Hickory.

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#21 of 23 Old 08-01-2011, 02:30 PM
 
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#22 of 23 Old 08-10-2011, 07:41 AM
 
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Quote:
Originally Posted by lunarlady View Post

I told my OB my plan to HB, and it was fine. He did write in my chart something about "strongly counceled against plan to HB", but I honestly think it was more a CYA move so he wouldn't be liable. I did have to sit through about ten minutes of "why hospital is the safest place" and another ten minutes of "I really hope you will transfer if" but I was fine with that. He said he hoped I would feel comfortable enough with him to seek help at any point if I felt I needed it. He mentioned post partum issues, stiching tears, etc., and said his main concern about HB is patients not getting medical help when needed.

Honestly, i would do shadow care again in a heartbeat. I had an emergency transfer after the birth due to retained placenta and severe PPH. I came in by ambulance and the hospital was able to pull my blood type, prenatal records, etc. up instantly in their system. Since I was bleeding severly, it was wonderful to not be answering questions like weight, age, EDD, and so on in a true emergency situation. They had the information they needed to treat me immediately.

Obviously, I didn't have a c/s, but I also liked shadow care because if for some reason I needed to go under the knife my OB would come in to do the surgery. Not all OBs do that, but mine does. That meant a lot to me as I really fear c/s and being able to trust the surgeon cutting me is huge for me personally.



truedat.gif  Sounds like a good OB.

NOT pushy, but covering all the bases and giving you all the info you need to make an informed choice.

 

(Yes I know, he's going to come from a medical perspective. But then, the attending midwife is going to give you information about the same subjects from a midwife point of view, so it all balances in the end)


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#23 of 23 Old 08-10-2011, 07:55 AM
 
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If you do talk to you OB about it, come prepared.

 

His biggest care is going to be what will happen if there's an emergency.

 

Show him that you have a qualified, competent midwife who is equipped and trained to recognize emergencies (Fetal distress, PPH, etc.) and who will transfer you in a timely fashion to a hospital if it's something she can't handle.

 

He's still going to give you the talk about the dangers of HB and how hospital birth is safer (legal requirements and such to cover his own behind if something happens) but if he's a good OB, he'll be a lot more receptive to the idea.


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