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Discussion Starter · #1 ·
I had my fist appointment with my backup midwife who works at a large ob practice. I debated telling her I was really planning a homebirth but since going to their office with three little kids is a huge hassle I wanted to make sure she knew I didn't want to come to every 'scheduled' appointment and would be doing the majority of my care with the hb midwife. She first said "I won't be backup to a homebirth midwife" but then she seemed to soften and by the end of the appointment was talking about coordinating care.

Today I received a certified letter in the mail saying that, after taking with the doctors in the practice, they have all decided to discharge me from their practice. The reason they gave was "We do not feel your idea of birth is compatible with ours". I don't see it as a liability thing since this particular practice (according to the initial paperwork and big sign on their wall) has "chosen not to carry malpractice insurance". It's not like I could even sue them if something went wrong - why are they taking such an issue with me?

I called the HB midwife to set up an appointment next week. We were planning on waiting another two weeks until the other practice did an ultrasound to come up with a solid due date because it's easier to have it done there than deal with all the paperwork for one through her.

I'm annoyed that a medical practice, especially the only one with midwives that takes military benefits, would do that to a patient but it does feel good to have jumped head first into homebirth for my fifth baby without a safety net!
 

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I just got fired too, and have been told this is very common. To me, it just goes to show that the health of women and babies doesn't come first--it is all politics. Arranging back-up care (and finding care one can afford) is responsible and should be admired, not a cause to be let go.
 

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Quote:

Originally Posted by elus0814 View Post
I don't see it as a liability thing since this particular practice (according to the initial paperwork and big sign on their wall) has "chosen not to carry malpractice insurance". It's not like I could even sue them if something went wrong - why are they taking such an issue with me?
Fear of being sued is exactly why they fired you. Technically, you could sue them if something went wrong and since they don't have malpractice insurance, they are a greater risk of losing everything. Just because you don't have an OB doesn't mean you can't transfer to a hospital if you need to.
 

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Discussion Starter · #4 ·
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Originally Posted by smpayne View Post
Fear of being sued is exactly why they fired you. Technically, you could sue them if something went wrong and since they don't have malpractice insurance, they are a greater risk of losing everything. Just because you don't have an OB doesn't mean you can't transfer to a hospital if you need to.
I suppose I could if they were negligent but if a doctor chooses to not carry malpractice insurance they legally can do so if they can prove they have $250,000 in assets, which is the maximum amount a non-insured doctor can be liable for. Most doctors who go this route have a trust set up for that amount and that is the maximum they can have to pay - it doesn't matter how negligent they are or how much harm they do. When I was there I asked the midwife how it was possible that they don't carry insurance and she simply said "it's too expensive". I feel that it shows how little they care about their patients. They need to realize that they can make mistakes and if they do they should have the insurance to cover it. What if a life long injury was caused? $250,000 wouldn't make a dent in the expenses involved.

I can still go to the hospital, of course, if need be. The kicker is that since there are only two practices in town there would be a 50% chance of getting stuck with their doctor on call anyway.
 

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I think it also is an issue of multiple providers caring for/organizing care for the same person. If you had a broken leg, you probably wouldn't go to multiple orthopedic MDs for care since they might recommend different exercises/treatment. It's the same for OB care. I think a collaborative system where you have an OB backing up a midwife makes sense since one is for high risk scenarios and one isn't, but seeing a midwife while seeing another midwife doesn't make a whole lot of sense, although I understand the benefits of being "in the system" when planning a home birth.

I also imagine it also might be frustrating for the midwife too to be seen only as a formality--assuming she also cares about her patients etc.
 

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I didn't realize it was so common either. My OB is willing to do co-op care with the HB MW but says we are on our own once I go into labor. And I quote "It's not fair for me to have to clean up her mess" So now our back up is to just go to the emergency room if need be!
 

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Quote:

Originally Posted by elus0814 View Post
I feel that it shows how little they care about their patients. They need to realize that they can make mistakes and if they do they should have the insurance to cover it. What if a life long injury was caused? $250,000 wouldn't make a dent in the expenses involved.
That does not really make sense to me. Having insurance does not showing caring. Patient care does. And if you knew how expensive malpractice insurance was for OBs you may understand why they don't carry it. I know many OBs tha are no longer practicing OBs because of that very reason (my FP doctor is one of them).

As for being dismissed because you have other care. I did not know it could go any other way. I have never found a doc that would be "back-up". And if I let them know I was planning a HB, I was dismissed immediately. It is all about liability to them. Sad, but true. To get back up care, I have always had to hide my true intentions (not lying, just not divulging the true facts).
 

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Discussion Starter · #8 ·
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Originally Posted by Kidzaplenty View Post
That does not really make sense to me. Having insurance does not showing caring. Patient care does. And if you knew how expensive malpractice insurance was for OBs you may understand why they don't carry it. I know many OBs tha are no longer practicing OBs because of that very reason (my FP doctor is one of them).

As for being dismissed because you have other care. I did not know it could go any other way. I have never found a doc that would be "back-up". And if I let them know I was planning a HB, I was dismissed immediately. It is all about liability to them. Sad, but true. To get back up care, I have always had to hide my true intentions (not lying, just not divulging the true facts).
With several doctors in my family I have every idea of how much malpractice insurance costs. It is a cost of doing business. Not carrying it is akin to not carrying car insurance and just telling the other party after you get in an accident 'sorry, but insurance was expensive and I didn't think I would get in an accident'. Any profession has costs of doing business and being a physician is no different. A doctor who chooses not to carry insurance is being greedy - simple as that. They want to be paid in full but don't want to foot the bill for the costs of doing business. Doctors without insurance are pretty much saying to their patients that they feel they cannot make a mistake, which is a disservice to the patients and proves that they don't care about patients that get hurt.
 

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In Canada there is no such thing as a "back up OB"... if you have to transfer to the hospital, you get the OB on call (similar to giving birth there in the first place) I wouldn't worry about not having a back up OB but congrats on jumping into Homebirth with both feet
 

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Same thing happened to me with the CNM practice I was going to. I told them I was switching to CPM hombirth at 37 weeks and they sent me a certified letter saying they are no longer responsible for me, however, they would provide emergency care up to 30 days from the date of the letter. I liked that, since if I had to transfer I would be able to see one of the CNM's instead of a random OB.
 

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Quote:

Originally Posted by elus0814 View Post
With several doctors in my family I have every idea of how much malpractice insurance costs. It is a cost of doing business. Not carrying it is akin to not carrying car insurance and just telling the other party after you get in an accident 'sorry, but insurance was expensive and I didn't think I would get in an accident'. Any profession has costs of doing business and being a physician is no different. A doctor who chooses not to carry insurance is being greedy - simple as that. They want to be paid in full but don't want to foot the bill for the costs of doing business. Doctors without insurance are pretty much saying to their patients that they feel they cannot make a mistake, which is a disservice to the patients and proves that they don't care about patients that get hurt.
Sh*t happens. Most people don't get a dime when life screws them over. $250k isn't chump change.
 

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When I went to see my "backup" OB this time, I stated it this way: You don't have to meet with me, and you don't have to coordinate care with my HBMWs, but if something goes wrong or if we feel the risk of staying home is too high, we're coming to your hospital, so it's in both of our best interests to have some conversations ahead of time.

By refusing to work with you, I feel that they are *increasing* their liability, because then, if something goes wrong, you will still be at their hospital and under their care, and you can sue them for refusing to assist you prenatally, especially since you came to them in honesty and good faith. In no other aspect of medicine have I heard of a doctor "firing" a patient because their decisions about care did not meet with the doctor's recommendations. An oncologist does not "fire" a cancer patient for choosing not to undergo chemotherapy, for instance. It drives me crazy.
 

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Quote:

Originally Posted by aylaanne View Post
When I went to see my "backup" OB this time, I stated it this way: You don't have to meet with me, and you don't have to coordinate care with my HBMWs, but if something goes wrong or if we feel the risk of staying home is too high, we're coming to your hospital, so it's in both of our best interests to have some conversations ahead of time.
WOW that is really good. I'll have to remember it.
 

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Discussion Starter · #15 ·
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Originally Posted by aylaanne View Post
When I went to see my "backup" OB this time, I stated it this way: You don't have to meet with me, and you don't have to coordinate care with my HBMWs, but if something goes wrong or if we feel the risk of staying home is too high, we're coming to your hospital, so it's in both of our best interests to have some conversations ahead of time.
That's good. I was told by my insurance company (tricare, military benefits) that it is illegal for a doctor to 'fire' a patient based on personal opinions, which this (in their opinion) was but since the midwife was the one who signed the letter (on practice letterhead) it's a gray area since it is legal for a midwife to dismiss a patient for personal reasons.

I suppose I can't complain too much since because this was the only 'in-network' practice with midwives and I would like to see a midwife they have put in a referral for an 'out of network' midwife of my choosing. I gave them the name of the homebirth midwife and they said it was fine. I spoke with her again and they are going to pay 100% of her charges instead of 80% or 50% (depending on if I changed plans or not) so in a strange way the hospital midwife has saved me anywhere from $850 to $2500. Maybe I should write her a thank you note
.

I think you're right, it would be in their best interest to continue care in one form or another.
 

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As another military wife going with a homebirth midwife but who went to an OB to get tests and such covered by insurance I have to say I understand a bit. Only now that the tests are done I am firing the OB. They are horrible!

They talked me into tests I did not want and told me that the TB test is now standard care across the country and it just isn't. They talked about all the great extra ultra sounds they could do in their office and not on post if I have GD even though I made it clear I do not want to take those tests and rather keep a journal and test myself. They wanted to do everything Tricare would cover.... as if thats a good thing. I can only picture what birthing with them would be like. -shiver-

I think your safer without them!
 

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I am an RN. I worked for my OB/GYN. They induced my first baby and then did the C/S the next day. For baby #2, I continued to work there, I had care with them, and they were aware of my strong desire for a VBAC. They knew nothing about my homebirth plans and prenatal care with a midwife. I had my baby peacefully at home on a Saturday. I called my doctor at her home the next day to let her know. She was surprised, but kind, asked the normal doctor questions (bleeding, stitches, etc.) and told me to call if I needed anything. She even offered to do my post partum check up. On Tuesday, yes, 2 days later, I recieved my "discontinuation of care" letter. I had felt bad about deceiving them throughout my pregnancy. This proved I had done the right thing.
 
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