when to sever ties with the OB

labortrials · Dec 14, 2010

Brief history:
2004 - natural birth ended when I consented to letting the CNM break my water; my daughter got stuck, and I had a c/s <img alt="irked.gif" src="http://files.mothering.com/images/smilies/irked.gif" style="width:15px;height:15px;">
2007 - started planning for HBAC but lost 3 pregnancies in 2007-08 <img alt="angel1.gif" src="http://files.mothering.com/images/smilies/angel1.gif" style="width:38px;height:15px;">
2009 - homebirth was taken off the table because I was pregnant with twins. OB was mostly supportive of my insistence on VBAC. Both babies flipped breech in the 3rd tri. Baby A chose their birthdate with her feet. <img alt="2twins.gif" src="http://files.mothering.com/images/smilies/2twins.gif" style="width:16px;height:16px;">
2010 - oh my, I'm pregnant again. I need progesterone supplementation, which meant re-establishing with my OB. However, no OB in town will support VBA2C, and I'm not interested in "fighting" them on it.
 
So, due to my history of loss, I've been on progesterone supplements and have had 2 quick u/s to check viability and growth. But it is certainly not my plan to continue with an OB. I may have to stay with him through 20 weeks for my campus's "well baby" program to cover the u/s.
 
So how do you sever ties with an OB? What if I end up needing obstetric care later in the pregnancy? OTOH, I think being cared for under the medical model is making it harder for me to really plan for and believe in my upcoming homebirth. Don't know if that makes sense. It's just too much access to intervention, and that keeps me in a somewhat interventive mindset and makes me think I need access to all of that stuff. I'm sure it's complicated by my history.
 
TIA for any advice!

Comtessa · Dec 14, 2010

Everyone has their own comfort level with this stuff, but in my experience, having a relationship with an OB all the way through my pregnancy was a good idea. I really wanted to drop him when I got closer to my due date, esp. because the once-a-week visits were getting ridiculous and everything was normal, but I stayed with him for DH's sake (DH was terrified of HB and having an OB saying everything was OK was the only thing that kept him from panicking). 
 
I ended up with a non-emergent transfer at my HB, and when I got to the hospital I got much better treatment than I would have, if I had not had a full record of prenatal care with one of their staff OB's. He had signed off on my transfer birth plan, and that made a huge difference in the kind of care I received. 
 
I think that if you DO end up needing to transfer, the difference in your experience might be significant (especially with a VBA2C) if you have care 'on file' with an OB somewhere. Plus, you're less likely to end up stuck with whichever doc is on call that day (the on-call doc at our transfer hospital was straight out of a horror movie. Really). 
 
So my vote, IME, is to stick it out with the OB. Be as honest about your HB plans as you can (you might not be able to, every doc has her/his own comfort level with this), and just don't let the 'medical stuff' phase you. Stay strong and keep believing in your birth. You can do this!!!

msmiranda · Dec 14, 2010

So it sounds like there are two questions: should you continue with shadow care throughout the pregnancy or not? And, if you decide not to, how do you sever the relationship?
 
The answer to the second question is easy: you just don't schedule any more appointments once you decide you're done. (Unless you want to preserve the possibility of returning to the same doc and can be honest about your plans). It's the first question that's tough.
 
I'm a very just-in-case type myself, and I really wanted to have shadow care last time (my first HB). But it just got too stressful, particularly after I declined the GTT, and so I stopped at about the 32-week mark. It worked out fine, I had an uncomplicated HB, but the biggest discomfort about HB to me is the lack of specific backup. (And my MW just told me that she has been treated worse at the closest hospital to my house than any other hospital she has transferred to. Yikes.) 
 
This time I have Kaiser for insurance and care, so it's not like in a private practice where they can drop you if you say the words "home" and "birth" in the same sentence. As many will, by the way. So I am going to be honest at 20 weeks and say "I'll be back if I need OB care, otherwise thanks for your care up to now." Not particularly looking forward to having the conversation, but I think it's for the best if I'm upfront with them. 
 
It sounds like you are inclined not to pursue shadow care much longer. So, for you, I guess the questions are: Do you want to preserve the relationship with this doc, or accept that you would have to find another if a complication arose later in your pregnancy that necessitated obstetrical care? If the former, do you know whether this doc would be amenable to that? If you don't know, I would try to initially feel him/her out without reference to yourself ("So a friend of mine told me to watch this really interesting documentary, TBOBB. What do you think about home birth?" ... or something like that). 
 
Honestly, in this area I would be SHOCKED to find an OB who would agree to be backup for any HB, much less a HBA2C. There are two or three OBs who do back up a local CNM practice that does home and birth center births, but I assume that this practice carries malpractice insurance. If your MW does not (as most HB MW don't), docs would tend to be afraid of a transfer of liability, i.e. if you show up as what they call a "train wreck" they could be held liable for any damages even though they were not your primary care provider. When I stopped going to the OB practice at 32 weeks in my last pregnancy, I assumed that if I transferred I would see the doctor on call at the hospital. I wasn't happy with that but I didn't see that I had any other choice.

when to sever ties with the OB

labortrials

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Comtessa

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msmiranda

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