[mamamook]

Hi there! Pardon me for jumping in on this forum, but I've been trying to research this question, and have found nothing helpful in google searches. I figured this would be the place to ask....

I'm contemplating going back to school to fill in the holes in my undergraduate education in preparation for attending med. school. Both of my babies were born at home and I am a huge advocate for MW-attended HB. I would like to get my MD in order to provide more women who feel the need to have a more conventional/allopathic care route with the opportunity to have natural, empowering births. I'd like to do some subtle (if I can learn to be subtle

) education from within the medical model - of patients and of other medical people.

So, in taking that path, would it be completely unheard of to also apprentice to a midwife, and then as an OB, attend homebirths? Or, perhaps, if I feel a patient of mine would be a good candidate for homebirth, I could refer them to a midwife (probably a good way to put myself out of business

). Would either of those be a medical-malpractice-disaster-waiting-to-happen kind of thing to do? Do any of you know of OB's who attend homebirths? And, if this type of practice is a possibility, do you know if I would be able to do it in Michigan?

I welcome any ideas or suggestions....

 

[birthdancedoula]

How about after you finish med school and I finish my CNM (I'll be done in '10) we open a homebirth practice?

I think its a great idea and wish more docs would feel the same way about birth as you do. Not sure about the liability/insurance implications for docs attending HBs but I have read about doctor-assisted HB...in IL maybe?

Regardless, I wish you the best of luck in your studies!

 

[GrrlyElizabeth]

Mayer Eisenstein is an MD in the Chicago area who attends births at home. His practice is the only one I'm aware of like it, but I'm sure there are at least a few other MDs attending home births. I would hazard to guess that family practice docs might be more likely to do it than OBs, but that's just speculation. Anyway, here's his website: http://www.homefirst.com/

I saw him speak at the LLL conference in July, and I really liked him. He does believe in normal birth, his practice c/s rate is something like 8%, he's really into holistic medicine, etc. I didn't agree with everything he said, but I have a lot of respect for him, and I plan to read one of his books.

Good luck to you! I imagine the road to being a homebirth MD will be challenging, but it would be wonderful to give women that option. It's also VERY valuable to provide midwives with the backup/support they need.

 

[birthdancedoula]

Quote:

Originally Posted by GrrlyElizabeth Mayer Eisenstein is an MD in the Chicago area who attends births at home.

Ah yes, he's who I was thinking of.

 

[bobandjess99]

Here in my state, the legal midwives who attend homebirths NEED a MD to back them up - this is true in many places - so, just by being a MD who was willing to back up homebirth midwives, you would be doing a HUGE service, whether you attend births yourself or not.

 

[lilsishomemade]

I think it would be awesome and I have a friend who is thinking of the same thing. She hadn't even thought of being able to back those of us who are wanting to become midwives ourselves up.

There are some greasy areas, though. I think some insurances would refuse to cover you if you openly do homebirths, or at least you'd be paying much more $$ for coverage. If you sign on with a particular practice, they may really frown on you wanting to do things different. Along with hospital staff, etc. I would think there'd be a lot of hostility, but if you're willing to deal with that, than I encourage you whole-heartedly!!

 

[mysticmomma]

how is it that cnm's can go without ins, but not md;s?

 

[Romana]

There's a good chance you would be unable to obtain med mal insurance in your state. Unless there is another practicing OB/MD in YOUR state who is attending homebirths, and whom you have not trained with or had a personal or professional relationship with, you will not be able to get med mal insurance for homebirths. This happened to my family MD, who stopped doing homebirths for that reason. They have to have someone they can call as an expert witness to testify that it meets standard of care, that homebirth is reasonable practice, etc. Midwife doesn't count - it would have to be another OB/MD. So I don't think you'd be able to get med mal. Some doctors go without, but that's a pretty tough position to stick yourself and your family.

Also, I would be surprised if you got through med school and OB residency without having some change in your perspective leading to a desire to hospital birth, at least in your practice. Very woman-friendly friends of mine have been pretty thoroughly converted by their experiences in med school and OB residency. It truly is a tradition and fear-based practice and it just bleeds through everything they say about it.

It's also quite difficult to work in a hospital doing hospital births if you do homebirths because the hospital sees you as a liability. It's not impossible, if you can get insurance (unlikely, unfortunately), but it is still difficult. Those births you do have in the hospital, there's a lot of scrutiny about how the birth is handled etc.

I do think there's a huge amount of good you can do being a naturally-minded and woman-centered OB doing hospital births. A lot of women do want to birth in the hospital, or would be happy doing so if they could just find a doctor who would support rather than undermine them. I really think you could do tremendous good in the hospital helping women achieve low-intervention births, and/or recognizing that a woman with one complication requiring a hospital or one medication doesn't mean the whole birth has to be high-intervention.

 

[lilsishomemade]

Quote:

Originally Posted by mysticmomma how is it that cnm's can go without ins, but not md;s?

Most CNM's I know DO have insurance. Heck, I had mal. insurance and I was only an LPN working in a nursing home! I have also known a few CPM's who have insurance, but I can't remember where they were and what they had to do to get it.

You certainly can practice without it. You probably won't have privileges at the hospitals because of liability issues. It's not recommended in our sue-happy country, though.

 

[Defenestrator]

You would have a much easier time as a family practice doctor than as an OB. What you might be able to do is work at a birth center as an OB. I do know of OBs in Indiana who attend birth center births (or at least did a couple of years ago when I heard of them).

Another question would be -- what kind of salary are you looking for? You may not be able to have much of a salary after your malpractice is paid if you aren't doing lots and lots of surgeries or a high volume of births.

 

[BinahYeteirah]

There is an MD here in Melbourne who attends home births. His name is Dr. Peter Lucas.

 

[mamamook]

Thanks for all the brainstorming. I'm getting excited about all the possibilities here. I'm now thinking about following the old path of the family doc who does house calls. "Well, I just went over to check in on her when she invited me in for a cup of coffee, and, omigosh she was in labor. She wanted a homebirth anyway, so I just stuck around in case she needed anything...."

Salary's not an important factor, as long as I can cover insurance, gas money, office lease.......

I'm pretty sure I have to take freshman biology and some other classes before even starting med school. And the little guy needs to get a little bigger before I can start that. So I've got some time, but it's fun to plan and dream!

 

[pamamidwife]

I think that it would be hard to have malpractice insurance if you were attending homebirths. I also think you'd have to choose one or the other: a private family practice or homebirths. I don't know if you could do both in terms of cost of malpractice.

To me, being a homebirth midwife is hard enough. Most FPs in my area with OB rotations pay about $90,000 to $120,000 for malpractice insurance. I cannot imagine what OBs pay - and if you are doing homebirths, you can bet that you're gonna be more "risky" to the insurance company (our malpractice insurance providers offer a lower premium for practices w higher cesarean rates).

I would think that being a midwife-friendly (meaning: collaborative care and offering care for transports) MD would be much more workable. Then again, I think becoming an MD is a hard road and takes alot of guts to get through. Not to mention I don't know how anyone makes it through medical school with any sort of faith in normal birth.

I'm just cynical and jaded.

 

[doctorjen]

Quote:

Originally Posted by pamamidwife I think that it would be hard to have malpractice insurance if you were attending homebirths. I also think you'd have to choose one or the other: a private family practice or homebirths. I don't know if you could do both in terms of cost of malpractice. To me, being a homebirth midwife is hard enough. Most FPs in my area with OB rotations pay about $90,000 to $120,000 for malpractice insurance. I cannot imagine what OBs pay - and if you are doing homebirths, you can bet that you're gonna be more "risky" to the insurance company (our malpractice insurance providers offer a lower premium for practices w higher cesarean rates). I would think that being a midwife-friendly (meaning: collaborative care and offering care for transports) MD would be much more workable. Then again, I think becoming an MD is a hard road and takes alot of guts to get through. Not to mention I don't know how anyone makes it through medical school with any sort of faith in normal birth. I'm just cynical and jaded.

Hey, now. Cut some of us a little slack

That said, practicing as a homebirth provider as a physician is pretty darn difficult, and getting through the training un-converted is probably even harder. There is a large homebirth physician practice here in my state (mentioned above) but it's not really much like midwife attended homebirths. They advertise "bringing the hospital to you" type treatment. They are doctors - you get a nurse or midwife to come support you during labor, granted, but then a doc comes at the end to catch the baby, just like in the hospital. If I were going to have a homebirth practice, that is not how I'd want to do it, but as a practicing physician, I don't see much way around that type of practice, either. They also share call among many docs, so that you get who's on call - also not how I'd want to do homebirths. I love to attend my own clients, and currently attending over 98% of them myself (I think in 6+ years and 300+ births I've missed 4 births)
It'd be pretty hard to manage homebirths with regular practice hours. It's hard attending hospital births, even. As a family doc, I do 60-70 births a year, and manage to be in the hospital during active labor for the grand majority of my clients, but it is darn hard sometimes when you have an office full of people needing you, and a laboring mama needing you at the same time. I even practice in a group, so there are folks to pick up slack, but not completely, so it is still hard. I have the luxury of not having to be there during active labor because I have trained nurses who can monitor my clients for me, but I don't like doing that. I feel that clients choose me, a family doc, because I can provide a less medicalized, more personal attended birth and I try hard to provide that by being there while my clients labor, providing support and the confidence of having a trusted provider right there with you through the whole thing.
The training is long and hard. Not to mention expensive. You may not care about your income, but if you have $200,000 worth of loans, you may have no choice but to care. Throw in malpractice (which in my state is nowhere near what Pam quotes, thankfully) and you have to make enough money to make a living. You may choose to "go bare" and have no med/mal, but many hospitals will then deny you privileges, and you would may not have the capability to care for your own clients who needed hospital services.

I don't want to totally dismiss the idea, but you need to know some of the difficulties you'd face.

 

[pamamidwife]

jen, the whole time I wrote that out, I kept wanting to say "well, except for doctorjen".

 

[pamamidwife]

Quote:

Originally Posted by doctorjen Hey, now. Cut some of us a little slack That said, practicing as a homebirth provider as a physician is pretty darn difficult, and getting through the training un-converted is probably even harder. There is a large homebirth physician practice here in my state (mentioned above) but it's not really much like midwife attended homebirths. They advertise "bringing the hospital to you" type treatment. They are doctors - you get a nurse or midwife to come support you during labor, granted, but then a doc comes at the end to catch the baby, just like in the hospital.

I have to agree with this wholeheartedly. This practice also does nothing to support homebirth midwifery legislation in their state and totally avoids the mention homebirth midwives in his book on homebirth. This practice is almost completely opposite of what most women get with the care of a homebirth midwife.

 

[mclisa]

You can't do it. Americans love their lawsuits too much. Maybe of tort reform happened.

Good luck if you try though

 

[mamamook]

I guess part of my goal in this thinking is to be able to provide people with a midwifery model of care (perhaps without them really knowing that at first

), while also assuring that in the rare instance transport is needed , care will be truly continuous and the intrusion of strangers into labor kept to a minimum. So, maybe the collaborative care kind of model that pamamidwife suggested is what I'm looking to do. I guess providing a close back up, prenatals with the midwife in the home, etc., and then being available in the unlikely event of a transport. And also providing care for women who choose a hospital birth.

In a way, I'm glad the schooling I need to do to follow this path is going to take a long time, because there are really alot of choices to make.

 

[courtenay_e]

Rachel, there is a doctor in our area who does what you mention. He pays lip service to the fact that hospital birth is safer, but backs up the homebirth midwives in the area (in fact is getting his fingers slapped for keeping NICU nurses out of the room because the family wanted it that way and that's the way he practices--giving the client the choices, I mean, not keeping them from care...). His practice/hospital is actually about 15 minutes from the mall, if that gives you some idea of how close it is... He has a midwife in the practice, but I don't think she attends births, from discussions I've had with clients. I actually recently attended a birth where he threw the Resident out of the room because he treated the laboring mother like she'd have been treated under other doc's care. It was a wonderous thing to behold. He even actually said to me three separate times during that birth that he appreciated my presence, and that it was wonderful that I do what I do. But docs like him are sooo few and far between...I can't say that I WOULDN"T mind having you around to support me when I start attending births as a midwife. It'd be wonderful to know that there was another doc around who saw birth as a normal event! Getting there...that's the rub...

Stacia, am I wrong, or is there also not a Dr. in our GENERAL area who does homebirth?...trained as a midwife first?...I thought you said you attended a breech birth that she caught at? Maybe I'm dreaming, it is late, but that's what I thought you said.

I think that, in theory, it'd be a wonderful thing to do to train as a CPM and then go on to get an MD. At least you'd have seen a BUNCH of normal births handled normally before "they" tainted you.

And we have some wonderful midwives in the area to work with and learn under.

 

[MidwifeErika]

I think if you feel called to be a doctor, there are many great things you can do for birth other than just attending homebirths. It would be fabulous to have more doctors out there supporting homebirth, backing up midwives, providing great care to transports, etc. I wish you lots of luck in all your decision makings!