Home Birth OB/Gyn Experience

[Pollyanna]

MrsK makes excellent points. Like I had said before, she shut him down before he could even ask her any questions. While asking for an "open-minded" OB/GYN she was completely closed to answering any questions about her own choices and her own health. Her title for the blog is exceedingly insulting to those of us who have spouses that dedicate themselves to the care of women. Who spouses can't sleep at night because they are worried about a patient and her baby. Whose spouses miss out on their own family because they are caring for other women. It is standard fair for some folks who choose homebirth to vilify OB/GYNs. Have a homebirth if you want but know the risks and do it because that is what you want to not because you think OB/GYNs are out to "get" you.

The women in this blog is so self centered it is obnoxious. She bitched about everything, the paperwork, waiting for 20 minutes past her appointment time, and then waiting for the doc to "grace her with his presence" as she stated. She went in with a bad attitude. She then was beyond rude to the doctor. She wanted what she wanted and was not interested in talking about her choices. If she was so "open minded" then she could have explained why she chose homebirth, etc. She did none of those things. She waited until the last minute to get BC and then blamed the doctor for not being able to get it. She was irresponsible in that regard and like Angie said she could have simply used condoms for the interim.

SoonerTexan, I know you have met this women and like her and I know you are partial to homebirth. It is wonderful that your mother has had such great experiences and I think it is great if that is something you choose. But choose that path because you want it, choose that path and accept the responsibility that comes with a homebirth. It is true that most deliveries are no big deal and don't need to be staffed by a physician but that is not always the case. Make sure you can be in the OR in less than 5 min if something goes wrong. Like I said before, the goal should be healthy baby/healthy mommy, that is the homerun, not the birth experience.

Truly, I don't think this thread is a vilification of homebirth but of this woman and her blog.

[scrub-jay]

I agree with Tara here - be close to a hospital if you are home birthing and have a solid plan. The word "midwife" can be misleading, Certified Nurse Midwives are medically trained (mine were also all faculty nurse midwives with doctorate and/or masters degrees) but other midwives can have significantly less training. For anyone looking into the home birth route, I recommend really doing the research and finding someone who has enough training/experience to make you comfortable. We were very happy with our experience with CNMs in a hospital setting.

To conclude - I support any birthing option, as long as you are realistic about possible outcomes. I wanted a natural birth, but if I had to have a c-section or any other intervention, I ultimately wanted to deliver a healthy baby - ANYWAY that I had to. *sigh*

It was too late. She shut him down before he could give her a chance. If I had an initial interview with a potential client and they told me that they just wanted me to write a contract that said X without being "lectured" regarding whether it was enforceable or legal and that they fired their last lawyer because he refused to write the contract, I'd walk out. Doctors, like lawyers, provide professional services -- not products and not guaranteed outcomes. They are hired for their knowledge and expertise. If a patient comes in and says "I'd appreciate not being lectured" that's a big red flag. Yes, patients should be able to make informed decisions about their health but it's dangerous for doctors to work with patients that are defensive and combative. "I'd appreciate not being lectured" is like the phrase "with all due respect." It's rarely said politely and is usually a battle cry.

Also late chiming in, but this is what I was thinking too. In my law practice, new client screening is seen as the most important step in preventing frivolous malpractice claims. Client acting defensive and client expressing displeasure with prior lawyer are huge red flags. Some people are predisposed to be unhappy with professional services rendered. I don't know whether physicians in private practice have a similar perspective on screening new patients, but I think in this case if the OB did not feel that he had established a rapport with her and had reservations about treating her, he acted reasonably in refusing. That said, and to the original question, I don't think it would be reasonable to refuse to provide care ONLY because this woman had a homebirth. However, even though the blog post presents the story as though that's what happened, I guess I find it hard to believe that there is not more to the story. As transcribed the conversation doesn't make any sense.

[medpedspouse]

MrsK makes excellent points. Like I had said before, she shut him down before he could even ask her any questions. While asking for an "open-minded" OB/GYN she was completely closed to answering any questions about her own choices and her own health. Her title for the blog is exceedingly insulting to those of us who have spouses that dedicate themselves to the care of women. Who spouses can't sleep at night because they are worried about a patient and her baby. Whose spouses miss out on their own family because they are caring for other women. It is standard fair for some folks who choose homebirth to vilify OB/GYNs. Have a homebirth if you want but know the risks and do it because that is what you want to not because you think OB/GYNs are out to "get" you.

The women in this blog is so self centered it is obnoxious. She bitched about everything, the paperwork, waiting for 20 minutes past her appointment time, and then waiting for the doc to "grace her with his presence" as she stated. She went in with a bad attitude. She then was beyond rude to the doctor. She wanted what she wanted and was not interested in talking about her choices. If she was so "open minded" then she could have explained why she chose homebirth, etc. She did none of those things. She waited until the last minute to get BC and then blamed the doctor for not being able to get it. She was irresponsible in that regard and like Angie said she could have simply used condoms for the interim.

SoonerTexan, I know you have met this women and like her and I know you are partial to homebirth. It is wonderful that your mother has had such great experiences and I think it is great if that is something you choose. But choose that path because you want it, choose that path and accept the responsibility that comes with a homebirth. It is true that most deliveries are no big deal and don't need to be staffed by a physician but that is not always the case. Make sure you can be in the OR in less than 5 min if something goes wrong. Like I said before, the goal should be healthy baby/healthy mommy, that is the homerun, not the birth experience.

Truly, I don't think this thread is a vilification of homebirth but of this woman and her blog.

ITA

SoonerTexan - if you and your DH choose homebirth, I am 100% positive that it will be because it is the best choice for you, your family and baby. I have absolutely noooo judgement on this woman's choice of homebirth either. Her behavior regarding her last OB/GYN visit is another story. Like I said, maybe she was just having a bad day and was hypersensitive about the questions asked.

[ladymoreta]

I agree - I think this was just a bad misunderstanding. The Dr. thought she was not willing to comply with the full exam (including questions), and she thought he was going to be rude to her. According to her description of the event, neither gave the other a chance to clarify.

So, I doubt his refusal to treat her had anything to do with her choice of a home birth. I don't think many doctors would outright refuse to treat a patient for that reason, as they often treat women who do truly dangerous things - like take drugs while pregnant. I think he was just not willing to treat her because of her attitude, which at best would have continued an unpleasant Dr/patient relationship and at worst might lead to a malpractice lawsuit for him.

[scrub-jay]

Honestly, I think the patient should have shopped around before slamming this doc. If she didn't feel comfortable with him, she should have just said so and found another that *she felt* was more accepting of her views. I think there is some responsibility on her part IMHO.

[Sheherezade]

I *know* that docs don't routinely refuse women that have had home births. That never even occurs to me. I routinely hear about people being seen that had home birth or "baby was born at home". The docs I know may not approve or assist in a home birth - but they do see patients that have chosen this route. Maybe that has colored my perception of the this event as well. Her assumption that the doc refused her care because of the home birth - and his assumption that (because she had a home birth and IF she said she did not see a doctor for care and did not also say that she was seeing a midwife regularly in this brief interview) she would be a difficult patient added up to a tense encounter.

I would like to state for the record that I know the OB/GYN field is much more accepting of midwives and home birth than they are thought to be. I don't think my husband has worked in a department that doesn't also employ CNMs since he started training.

[GrayMatterWife]

If I had an initial interview with a potential client and they told me that they just wanted me to write a contract that said X without being "lectured" regarding whether it was enforceable or legal and that they fired their last lawyer because he refused to write the contract, I'd walk out. Doctors, like lawyers, provide professional services -- not products and not guaranteed outcomes. They are hired for their knowledge and expertise. If a patient comes in and says "I'd appreciate not being lectured" that's a big red flag.

Oh, yeah. There's no way I would take that client. I'm not a rubberstamp. I mean, there's no reason to be condescending to anyone, especially a client, but sometimes you just have to have HARD talks. Part of my job is to provide advice. If you want a parrot, I'll have to abdicate my bar card to do it. I am sure a physician would feel the same way.

[Meenah]

I find this thread fascinating. Not just from the OB perspective. I have patients who come in "just wanting the RX that they think they need" and getting pissed when I won't give it to them. I always explain why, and I always ask alot of questions that are necessary to ask, if I want to provide good, safe, medical care. There are always some patients who will get pissed off and when you try to explain, they are not listening anymore. Asking about a patients sexual behavior, birth control plans, etc is a part of their medical history, and if I don't ask I could potentially harm them. Antibiotics are the biggest problem for me. People always think they need them, when most of the time they do not. I have had a few who were angry with me when I have told them they don't need the antibiotic but they do need Prednisone, refuse and insist on seeing the doctor. Three hours later when they come back and see the DH, 99% of the time they usually walk out with a Rx for Prednisone!!!!! It is funny, because after that happens they usually trust me the next time. Sorry for the hijack.

[scrub-jay]

I would like to state for the record that I know the OB/GYN field is much more accepting of midwives and home birth than they are thought to be. I don't think my husband has worked in a department that doesn't also employ CNMs since he started training.

I believe this to be true from the patient perspective. There was no adversarial relationship between the CNMs and the OB/GYNs. The CNMs were quite up front that they attended normal pregnancies (high risk pregnancies were usually seen by OB/GYNS). The CNMs in the practice we chose did not do home births, my guess is that they would still see a woman who chose that route because they (like OB/GYNs) are big supporters of regular prenatal care. The CNMs and OB/GYNs were very respectful of each others practice and the OB/GYNs were available to help out the CNMs if a delivery became complicated - I got the feeling that the practices were not competing, they both wanted the delivery to go smoothly.

She didn't--she was under the care of a midwife with monthly and then weekly appointments throughout her pregnancy, though I guess some would consider this no prenatal care. I followed her blog during this time and her midwife kept a close watch on her weight gain, because they were worried about gestational diabetes, and she wrote she would have not had a home birth had she tested positive.

I'd have to agree, though based on her previous posts I think it was more a problem of getting an appointment on time and fear based on her last experience.

I'm going to try and back away now...it's just harder to read some of the stuff since I have met her, and while I don't consider her a friend necessarily, I feel like I know her somewhat well based on her blog. It just seems more personal, especially since I hate to think my mother ever experienced something similar (though since most of my siblings were home born but doctor delivered, I don't think she did), or that I will myself someday. I really wish I knew the details of what happened now. You all made some good points about what the doctor might have been thinking/assumed, and while I still think he is at least 1/2 to blame for the situation, I have a feeling there was a lot of misunderstanding. At any rate, it is time to get my name changed

FWIW - this is tame compared to the last discussion I remember re: home birthing. I don't think people are vilifying the choice at all, but saying "Not for me and here is why." I also think that b/c you've met the woman your read her stuff through her "tone" and may not read as much into it and/or the same way as those of us who are reading her for the first time. We're also (many of us) reading it from the "other side", from the perspective of being married to practicing physicians and/or residents who have encountered patients who DO expect to walk in, say what they want, and expect it to be given to them. Her post, her words read a lot like that, and I didn't discount her because I think home birth is crazy (I don't -- it's not for me -- but as long as you take responsibility for your outcome, to each her own), I based my opinion on the tone of what she wrote and how she reported it back. I'd assume everyone writes to color themselves in the best perspective, and even what she wrote didn't paint her very well. As I said before, the doc probably could have been more diplomatic as well, but I don't blame him for refusing to continue when she wouldn't discuss her prenatal care and birth.

Plus, she wrote this in response to someone saying that doctors aren't just pill dispensers: I said this above but why AREN’T they pill dispensers? Why isn’t part of their description to determine if someone needs the medication they are asking for? Isn’t that partly what we are paying them for?

I think she sees the "needs medication" portion of this as "I want birth control so give it to me."

[Pollyanna]

I was a hospital birth. I also almost died and now have cerebral palsy because the doctor gave my mom pitocin since labor wasn't going according to the doctor's personal schedule. Awesome, right? But nobody cares about anecdotes like.

I don't think that is true. Those of us closest to the field know all to well that things can and do go wrong. Hell, sometime midway through dh's residency I asked him, "do you guys have any normal happy deliveries"? Like I said, my dh regularly loses sleep, checks on patients all night because he cares about them and worries. Hell, the poor guy can barely eat when I am pregnant because things do go wrong even under a doctors supervision and even in the hospital. But this thread is not about what can go wrong with hospital birth or even with homebirth but more about the attitude of this woman for one physician and physicians in general.

[Pollyanna]

I mean in this great debate (I don't mean specifically with this group, I mean overall), no one cares about anecdotes like mine. It makes no difference. An injured baby in a homebirth is met with "OMG IRRESPONSIBILITY!!!!!!!!" An injured baby in a hospital birth is, "well, sometimes these things do happen unfortunately."

I agree this is true. I think people always to someone to blame and it is easy to find blame in a homebirth situation. It is not so easy in a hospital situation because most people are not aware of how many things can and do go wrong at birth. They just cannot imagine you would walk into the hospital during labor and not come home with a healthy baby. The reality is that there are doctors that make poor choices and sometimes despite everyone's best effort things go wrong.

[GrayMatterWife]

FWIW - this is tame compared to the last discussion I remember re: home birthing.

Some people get completely religious about stuff like home births, breastfeeding, co-sleeping, working outside the home, etc. Women love to judge other women. You never see men in rabid fights about whether their wives are breastfeeding. Personally, I still say, To each his own. But no side should shove the wrongly implied morality into the equation. It's not a moral decision. It's a personal preference. You may think it's nuts to do something other than what you prefer, and you may have fantastic arguments for what you prefer, but it's still not a moral decision.