Ending shadow care? - Mothering Forums

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#1 of 11 Old 06-30-2013, 11:43 AM - Thread Starter
 
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I have been seeing an OB and a homebirth midwife up until now (26 weeks).  It's becoming tedious, and I have reached the point where I'd like to discontinue seeing the OB.  Are my reasons, well, reasonable?

 

*OB is one of four in a hospital practice.  Either way if I have to transfer, I get whoever's on call.  My OB's labor practices SEEM to be pretty natural, but I have no guarantee that I'll get him. 

 

*My pregnancy is going along very nicely and "normally".  No complications, no swelling, no sugar problems, blood pressure is fine.

 

* DD's pregnancy and birth was fine, except for some slightly cascading interventions that I'm trying to avoid this time.

 

*I'm really just tired of going to both appointments, and it's going to get worse when they're biweekly and weekly!

 

Am I missing something?  SHOULD I keep going to the OB?  I think I'm really nervous about telling him at the appointment next week.


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#2 of 11 Old 06-30-2013, 11:48 PM
 
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The only reason I see for shadow care is if you think you might need the backup at the time of birth. So I would figure severing ties would defeat that purpose. However, if you don't feel like you need it (and you likely don't!), then it may do no harm. I know some people just skip some appts, too. It really just depends on what your reasoning was for seeing both.

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#3 of 11 Old 07-01-2013, 05:40 AM
 
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In case of complications in pregnancy or just needing extra reassurance at the time are also valid reasons for shadow care. My births with midwives I didn't see an OB too, it was lovely and I felt comfortable with only seeing the MW plus monitoring my own health between visits. If you tell the OB you may get an earful about how they feel it is unsafe, but you have seen the stats on both sides and made your homebirth choice already I am sure. In the absence of "high risk" things and existing complications or even of intuition warnings, I'd say it's best to fully commit to HB and not hedge your bets, you can still transfer if there is truly a need.

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#4 of 11 Old 07-03-2013, 10:44 AM
 
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Would the OB be open to a more relaxed schedule?  I see a family doctor who has privileges at the hospital, but I only see her, oh, four times or so throughout the pregnancy.  However, my homebirth midwife and her have a pretty good working relationship though, so that might make a difference.

 

If you want to drop the shadow care, then by all means, it is kind of a pain when all you do is pee in a cup and listen to the doppler yet again!!!


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#5 of 11 Old 07-03-2013, 11:27 AM
 
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If it were me, I would base the decision on my past birth experiences and those of close relatives like mom, aunts, sisters.  In essence, I would go to the trouble of shadow care if there were any reason to suspect a complication, such as "I'm a first-timer but my mom had risky births",  or "my firstborn had several issues with fetal distress during labor", etc.  

 

In hindsight, I would try to find a practice with no more than 1 or 2 OBs that are reliable about showing up for their patients. 

 

I would probably not discuss my home birthing plan too much with an OB unless I was sure they were well educated about it, which excludes most of them sadly.

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#6 of 11 Old 07-06-2013, 06:34 AM
 
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I've been wondering this too. I've been hesitant to bring up the subject that I am seeing a MW and am planning home birth because I'm afraid how the OB will react. I just don't want a lecture, and I tend to get intimidated and just agree when I'm in a clinical setting, which is partially why I'm so committed to HB. Anyway, the only reason I was doing shadow care was to get the labs (esp. regarding strep B so I can start silver treatment or something to decolonize) & ultrasound to determine sex of the baby since this is our first. I'm super comfortable with my MW and HB, but at the same time, I work in the hospital that my OB works at (hospital & clinic are connected), so I could potentially be seeing her in the hallway, etc., for years to come. I just don't want it to get awkward, so I'm liking seeing if she is ok with relaxing the appt schedule rather than just dropping her completely. For the next baby, I will definitely stick with just the MW; it's far too complicated to juggle 2 providers!

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#7 of 11 Old 07-07-2013, 10:33 AM
 
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I just had my first baby (at home). When I asked at my first homebirth midwife appointment, she referred me to an OB who has seen some of the women she served in the past. I wanted to have the testing done to make sure I was truly low risk and that the homebirth would be "safe." When I first went to see the OB, his policy was that he would treat me like any other patient, he expected that I would go to all appointments and then "oops she just didn't show up at the hospital." I was fine with doing that because he seemed very supportive of natural childbirth and if I ended up needing to choose hospital birth, I would already have an established relationship.

 

However, about halfway through my pregnancy, he got a lot of pressure from the OBs who back him up--he is in practice by himself so it he can't make it, they were refusing to cover him. (The other major practices in that city will send you a letter denying you further care if they find out you are having a homebirth). At first I thought he was going to drop me all together, which really would have been fine with me at that point because I felt totally comfortable with my HB MW and like you I was far enough along that there didn't seem to be any major issues coming up. In the end, he decided to continue seeing women who were planning on having homebirths on a "consultation basis" basically all the appointments that would have testing associated with them 12 weeks for heartbeat and labs, 20 weeks for ultrasound, 24 for GTT, and 35 for GBS, etc, (maybe more but I just can't remember). This worked out really well for me because I felt like I was truly making a fully informed decision, but didn't have to drive 45 minutes go to all the other worthless appts--IMO because all they did at those appts were the same things that my MW did--BP, fundal height, listen to heartbeat, ask if I had any questions, etc.

 

Anyway, to answer your question, I think those reasons sound fine. If you still do want to see the OB (for GBS? if that's something you want to know about) perhaps your OB would be open to this "consultation" relationship? Best wishes on the rest of your pregnancy and birth!
 

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#8 of 11 Old 07-07-2013, 10:46 AM
 
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I was seeing a CNM practice that delivers at hospital. I used them for a previous birth but really wanted a home birth. I did my US with them then transferred care after. My HB MW does send blood wk to a lab that's way cheaper than the office visit. She did my glucose test and iron testing. We are assuming I'm GBS+ since I had a uti last time so she's giving me a shot of antibiotics when I go into labor. That's the only thing I'm super nervous about is the gbs situation. Been looking at stats and praying we will be ok.
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#9 of 11 Old 07-07-2013, 01:49 PM - Thread Starter
 
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So I told the OB at the visit on Tuesday that we were planning a homebirth, but didn't tell him that I was ending care with him (too chicken!).  He just asked that we notify the office after the baby is born so that they aren't left hanging! 

 

They switch to two week visits at 28 weeks, and the next one would be the glucose test, so it's a good time to stop going.  I'm going to call tomorrow to cancel the next appointment and then call records to get copies of everything.  Kind of the sneaky way out, but oh well.


DD 2/08
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#10 of 11 Old 07-08-2013, 09:05 PM
 
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Quote:
Originally Posted by Monkey pants View Post

I was seeing a CNM practice that delivers at hospital. I used them for a previous birth but really wanted a home birth. I did my US with them then transferred care after. My HB MW does send blood wk to a lab that's way cheaper than the office visit. She did my glucose test and iron testing. We are assuming I'm GBS+ since I had a uti last time so she's giving me a shot of antibiotics when I go into labor. That's the only thing I'm super nervous about is the gbs situation. Been looking at stats and praying we will be ok.

 

Can't you test for GBS if you're concerned about it?


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#11 of 11 Old 07-08-2013, 11:17 PM
 
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Well I'm 39 wks. I had a uti at the beginning of pregnancy that tested + for gbs. So then it's just assumed I have it. Usually it's a good sign of being pos.
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