Wrong to deceive your doctor? - Mothering Forums

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#1 of 9 Old 03-14-2011, 11:28 AM - Thread Starter
 
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I'm still doing research on the subject, but I think there's a huge chance that having a CNM do my homebirth is completely ruled out here in Dayton OH...so which leads to the question- would it be wrong to receive medical care from an OB throughout the pregnancy, just to make sure I am, in fact, lowrisk, while secretly planning on having a lay midwife deliver my baby at my home?  I want to make sure my baby is safe, but REALLY don't want to give birth in a hospital. In a perfect world I could have a CNM come to my home (or go to theirs), do all my prenatal care, know exactly what kind of patient I am, know me inside and out so when it comes time to deliver there shouldn't be any surprises...but I'm finding that can't be the case. Are lay midwives medically trained at all? In case something medically bad goes wrong, what are their capabilities? This is my first child and I want all- natural, at home,but also want to be safe and smart. I know this is a long winded thread but I could really use some guidance. Thank you to anyone who can help :)

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#2 of 9 Old 03-14-2011, 12:10 PM
 
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What you're describing is commonly referred to as "shadow care" around here, and it's not uncommon.  Since informing your OB of plans to have a homebirth could mess things up (they may have to terminate you from care for insurance reasons), it would probably be best not to inform the OB of that set of plans.  However, IMO, it is very foolish to lie to your OB about anything that affects your health during pregnancy, so other than that one fact, I would advise you to be as honest as humanly possible.

 

The CPM credential doesn't seem to require a whole lot in terms of training - I mean, it seems like a lot, until you compare it to the amount required for a nurse midwife or an OB.  CPMs typically see fewer births than OBs and CNMs who work in hospitals (CPMs can't guarantee to be available to their clients if they take on more than 3-4 who are due in the same month, and that's a big limitation), so they are less likely to have seen some of the complications that can arise during labor.  Some CPMs and lay midwives are extremely skilled and highly qualified, while others are not.  You cannot rely on the credential to tell you what you need to know, you need to question the practitioner, run google searches on her, and talk to her other clients.  I cannot stress enough that you really need to ask the uncomfortable questions:  how often does the midwife transfer patients to the hospital?  what conditions does she transfer for?  how long does transfer typically take, from the time the decision to go is made to the time you get to the hospital (the time it takes to drive from your home to the hospital is NOT the same as how long it takes to transfer)?  has she ever lost a patient (either mom or baby)?  would she come with you if you had to transfer to hospital?

 

IMO, you should be looking for someone who has a transfer rate around 10-15%, who has some experience with the local hospitals, and who would stay with you.  It would be good to speak to some patients who transferred as well as some who had their babies at home.

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#3 of 9 Old 03-16-2011, 04:24 PM - Thread Starter
 
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Very informative, thank you sooooo much!

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#4 of 9 Old 03-18-2011, 08:39 PM
 
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MeepyCat

I need to jump in here and comment. I'm a CNM with a home birth/birth center practice. I have been a member of the board for our state midwifery organization for 5 years. I am one of only a handful of CNMs doing OOH birth in this state. A couple of your comments need correction or clarification.

The number of births I needed to manage and attend was much lower than what CPMs need to complete before they can take on clients of their own. And, at the time, the program I attended had much tougher requirements that almost all the other CNM programs. Our clinicals had to be completed in 6 months or less. For most CPM candidates, their clinical experience can be 2 years or more and they see far more clients and have more experience with OOH birth than I ever got. I have worked closely with some well respected CPMs and know that they are far more knowledgeable about normal birth than a lot of CNMs and most physicians. CPMs are experts in normal pregnancy and birth. If there is something going on that means you and the baby would be safer with a hospital birth they are going to be the first ones to tell you that.

Most CPMs limit the number of clients they take precisely so they can be available. They also usually work with another CPM who lives in the same area so if they are at one birth they have someone who can cover with a laboring mom until they can get there. I have been in the same situation and I rarely have had to call the other midwife. The babies just seem to work things out so that the midwife can be with both moms as she is needed.

Complications: my practice does about 40-45 births a year. This would make it a small practice. However, I have seen complications that other CNMs and several of the physicians had never seen before. It isn't a matter of whether the midwife has a small practice and is unlikely to have seen the more common complications. The question is whether she has learned what to look for, knows what to do, and understands her limitations. The length of her apprenticeship/clinicals also makes it more likely that she will have seen the more common complications and will have worked with someone who had experience handling those complications. She gets to see first hand, not just how the problem should be handled, but how it is handled in the context of the immediate effect on the family and the baby.

 

Rapunzel 624, if you aren't sure you can trust the CPM's experience, education or credentials then you may want to look at finding a physician who will give you the kind of birth you want. You should consider a family practice doctor who still does OB. So much of how the birth goes depends on a trusting relationship between the physician/midwife and the client/patient. You have to be able to trust them and they need to be able to trust you.

Personally I won't take on a client if I think she is choosing OOH birth as a default, as in she just doesn't want to hassle with hospital routines, or is afraid of what she'll be talked into. She needs to know why she is choosing OOH birth and to prepare for that birth. If her heart is divided and she would feel safer birthing in the hospital, she will end up back there and it's usually with a complication during labor. Then she ends up dealing with a physician and staff she doesn't know, has no relationship with, and with a crisis to boot. Not the best situation for trying to give birth.

Have an open heart and be clear about what you want and who can best help you attain that.

 

Linda
 

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Originally Posted by MeepyCat View Post

What you're describing is commonly referred to as "shadow care" around here, and it's not uncommon.  Since informing your OB of plans to have a homebirth could mess things up (they may have to terminate you from care for insurance reasons), it would probably be best not to inform the OB of that set of plans.  However, IMO, it is very foolish to lie to your OB about anything that affects your health during pregnancy, so other than that one fact, I would advise you to be as honest as humanly possible.

 

The CPM credential doesn't seem to require a whole lot in terms of training - I mean, it seems like a lot, until you compare it to the amount required for a nurse midwife or an OB.  CPMs typically see fewer births than OBs and CNMs who work in hospitals (CPMs can't guarantee to be available to their clients if they take on more than 3-4 who are due in the same month, and that's a big limitation), so they are less likely to have seen some of the complications that can arise during labor.  Some CPMs and lay midwives are extremely skilled and highly qualified, while others are not.  You cannot rely on the credential to tell you what you need to know, you need to question the practitioner, run google searches on her, and talk to her other clients.  I cannot stress enough that you really need to ask the uncomfortable questions:  how often does the midwife transfer patients to the hospital?  what conditions does she transfer for?  how long does transfer typically take, from the time the decision to go is made to the time you get to the hospital (the time it takes to drive from your home to the hospital is NOT the same as how long it takes to transfer)?  has she ever lost a patient (either mom or baby)?  would she come with you if you had to transfer to hospital?

 

IMO, you should be looking for someone who has a transfer rate around 10-15%, who has some experience with the local hospitals, and who would stay with you.  It would be good to speak to some patients who transferred as well as some who had their babies at home.



 


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#5 of 9 Old 04-06-2011, 10:58 PM - Thread Starter
 
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Mothercat, you are completely right. I wasn't comfortable with the whole idea, I just didn't know how to end up with the birth I wanted. I have now decided to just go ahead and do a birthing center. I had an appt this morning with a new office, I'll be using midwives instead of my ob. I have a really good feeling about my decision, and i love how they'll support a natural birth but I'll be in a hospital just in case. Just an fyi, I was/am fully prepared to do this on my own, my husband and I are taking Bradley classes, I'm on a strict diet and doing my exercises. I'm doing everything I can to help ensure a healthy birth! Thank you for everyone's informative input, I greatly appreciate it. :)


 

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#6 of 9 Old 04-07-2011, 10:59 AM
 
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I am very glad to hear that you have found an environment and providers you can trust and believe in. We can birth just about anywhere as long as we feel safe and can trust those around us.

As a midwife, thank you for being so honest with yourself about what you wanted  and how to get it. Hope you have a lovely birth.

Linda


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#7 of 9 Old 04-07-2011, 11:19 AM
 
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Quote:

Originally Posted by mothercat View Post

 

Personally I won't take on a client if I think she is choosing OOH birth as a default, as in she just doesn't want to hassle with hospital routines, or is afraid of what she'll be talked into.
 



I don't want to sidetrack the thread, but I was just curious about the comment. Can you expand on it? I see choosing OOH birth as default as unrelated to - possibly even exclusive of - fear of hospital hassling and such.


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#8 of 9 Old 04-08-2011, 12:35 PM
 
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I think rapunzel624 has her answer so maybe she won't mind if I answer your question too.

 

What I'm talking about are women, and sometimes their partners, who feel so powerless to speak up for themselves and ask for what they want and need from their hospital based provider that they choose OOH birth. They don't really want an OOH birth, because they actually feel safer in the hospital, but OOH birth seems like the only solution. They know they don't want most of the routine that the hospital offers, and rather than speak up, they avoid having to take a stand, or switching to another hospital based providers, etc. perhaps assuming that the experience they had with one hospital based provider will be the same with all of them.

However, because they also don't feel safe OOH there is a lot of fear expressed during prenatals, focusing on controlling minutiae,and  extreme planning for the most uncommon of occurrences. This makes for a lot of fear and adrenaline during labor because the family continues to focus on how unsafe they feel away from the hospital.

 

Their fears begin showing at the interview appointment in the types of questions they ask. I'm fine with questions about complications I've seen and handled, transports I've done etc.because families  have a right to know what I can handle. However, when we start getting into questions where I'm asked why I don't do something that the doctor or hospital does and the assumption is that anything less than that is not good care, I know this family will feel safer in-hospital.

 

So, yes, choosing OOH birth is a default position to hospital birth, but you and I have different contexts for default. I should have done a better job of explaining my context in the original reply.


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#9 of 9 Old 04-08-2011, 12:54 PM
 
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What you said makes sense, I agree that we just must see the concept of "default" as different.

 

Carry on :)


Homeschooling mama to 6 year old DD.

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