Dual Care? Yes or no? - Mothering Forums
 
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#1 of 14 Old 10-09-2007, 07:28 PM - Thread Starter
 
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We're TTC #3 and I'm pretty sure I want to HB the next time around. I'm just trying to figure out if I should go the dual care route. The 2 MWs in my area are NOT backed up by physicians.

The main reason I'm considering it is so I'd have an established relationship with the OB I'd want should I have to transfer. At hospital #1, I'd be at the mercy of whichever family practice resident happened to be on call that night. At hospital #2, there are no residents (and there are a couple of CNMs), but it's a small hospital and they transfer any complications/NICU to hospital #1. So if I were to need a transfer, it's entirely likely I'd NEED to go to hospital #1 anyway.

The OB I'd want would probably drop me from care if I told her I was planning an HB. However, I feel like it's dishonest for me to see her throughout my pregnancy and then pull an "oops, we had a home delivery" on her. I know some choose that route, but I'm not comfortable doing that.

Thoughts? Advice?

Jen

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#2 of 14 Old 10-09-2007, 07:53 PM
 
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I wouldn't bother. I wouldn't transfer unless it was an emergency and in an emergency you're going to get whoever is there anyway.

-Angela
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#3 of 14 Old 10-09-2007, 08:09 PM
 
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I wouldn't bother if the MW can provide the prenatal care you are looking for. If you want tests done like an ultrasound that your midwife might not be able to do that I would consider co-care to that point unless something serious develops.
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#4 of 14 Old 10-10-2007, 12:00 AM
 
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Not for me, no way. Not worth it.

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#5 of 14 Old 10-10-2007, 01:10 AM
 
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I did for the first part of the pregnancy. The back-up care was free, I wanted my insurance to cover the initial bloodwork I had done, and I had a history of preterm labor with my first pregnancy. I had 2 appointments with my Primary Care Manager, but that's all. It did give me a bit of a history with our local military hospital in case I went into preterm labor again. If I hadn't had that PTL history then I would not have gotten dual care. Plus, I had a really great PCM who was great about homebirth, even called after DD was born to hear my birth story.

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#6 of 14 Old 10-10-2007, 02:37 AM
 
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I haven't had dual care with this pregnancy. I tried -- I made a few appts and kept canceling them. I just cannot walk into a medical office knowing that I don't have a medical problem. Also, if I transfer, it will be an emergency and whoever is on call will get me, so no point in making any kind of relationship.

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#7 of 14 Old 10-10-2007, 03:05 AM
 
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At my MW's advising, I recently made an appointment with OBs/midwives at my local--and very well-known--medical center. I started the pregnancy with OB care in another state, and was able to decide what I wanted done. Now, all I need is a GBS test (in case of transfer), and some blood tests to check my iron levels. I preferred to go through the hospital, as insurance covers it, whereas it would be an additional expense through my MW. And if I needed to transfer, I wanted to see where I would be going.

Since I was seeking care at a late-ish date, the OB called me directly. Within the span of a 5-minute conversation, I received a flustered lecture on how my MW should be doing the tests, that I couldn't just "use" the hospital for diagnostics then deliver with a MW, and told I would probably need a c-section since my baby is breech...at 34 weeks. It was fine over the phone, because I could hide the nonverbal reactions to this ridiculousness, but that won't be so easy in person.

It's just a matter of how comfortable you feel navigating the system, and determining whether the frustrations outweigh the benefits.
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#8 of 14 Old 10-10-2007, 05:59 AM
 
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My HB MW strongly recommends against it, largely for the reasons already mentioned by others here.

I think it's not worth the trouble. I had already started seeing some CNMs before I found my CPM and now it's a huge ordeal to "break up" with the CNMs.

I suppose if you could find an OB and an HB MW that work well together, it might be worth it. But in the event of an emergency, you'll just get whomever's on call anyhow.

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#9 of 14 Old 10-10-2007, 08:30 AM
 
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I am doing dual care. My MW has a back up MD, and requires one visit with him during the pregnancy. He prefers for HB mamas to come see him as often as they are comfortable with, just because that way he gets to know them (since he's who you take the baby into for newborn check/pku test) and if there is a cause to transfer care during the pregnancy or birth there is a continuity of care.

Before I found my mw, I was seeing CNMs in the hospital. I just never scheduled my next appt- nobody called to see why or anything.
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#10 of 14 Old 10-10-2007, 04:40 PM
 
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I had dual care last time, but this was a homebirth-friendly office and my CNM didn't have a problem with it. I have a new CNM now, and she knows I had my second at home, and I'm almost 100% sure she won't mind that I have a homebirth midwife for the birth. We don't know what we're going to do yet because now I live 50+ minutes away from my homebirth midwife. We might split the visits, half I drive to her, half she drives to me. We'll have to work it out somehow.
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#11 of 14 Old 10-10-2007, 06:01 PM
 
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No...for me it'd be no way, no how. Since both of the states I've lived in while pregnant are not exactly hb friendly (CPMs are licensed, but that doesn't mean the medical folks like it) I've always preferred not to establish care with an OB or a CNM connected with the hospital. The only way I plan on transferring is in a medical emergency and I'd actually rather just get whoever's there.

Plus...for me it's just not worth the stress.
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#12 of 14 Old 10-10-2007, 06:05 PM
 
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Quote:
Originally Posted by alegna View Post
I wouldn't bother. I wouldn't transfer unless it was an emergency and in an emergency you're going to get whoever is there anyway.

-Angela
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#13 of 14 Old 10-12-2007, 01:01 AM
 
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Part of why I HB was to get out of the crappy Obstetrical system and all their compulsory "treatments". I couldn't dual care and do that unless I wanted to fight/argue with my OB every step. If I had an OB that was like my midwife I would. But then if I had an OB like my midwife she would have attended my HB . My OB was hostile to the idea of my HB and I really didn't think it is worth it to lie to get dual care.

Oh and yeah that to what Angela said.
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#14 of 14 Old 10-12-2007, 10:17 AM
 
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I'm sort of doing dual care. In my state, OBs legally can't back up a MW. However, the two MWs in my area both have good relationships with an OB (different obs, though). One of the OBs requires that you see him through your pregnancy, even if you're going to HB. The one I'm with agreed to see me for an US at 12 weeks and then again at 36-37 weeks. The last US is to get a good picture of the baby and make a good prediction about how delivery might go. I am completely comfortable with this since I wanted US anyway. Plus, I have a list of things that could come up DURING pregnancy (so not an emergency situation) that I would want to switch to OB care for, and it means that I have an OB that I can go to if that happens.

When I got pregnant, I had no idea about HB, and I was with a different OB in my area that dropped me b/c I ended up wanting to do an HB. Her practice was a real jerk about things, though. And one of the things they told me when I asked if there would be a possibility of transferring back if I needed to was, "well Dr. Donnelly sometimes won't accept patients who are later in their pregnancy. It all depends on how big her practice is, and right now her practice is booming." PSh... If all I am to them is another customer, I don't need them anyway.

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