Home Birth OB/Gyn Experience

[SoonerTexan]

I've followed this girl's blog for the past year, and came upon this post today about her experience with a local OB/Gyn:

http://thatwifeblog.com/2010/06/if-y...e-a-homebirth/

I'm honestly curious to know what everyone here (especially the ob/gyn wives) think of this? In the blogger's defense, she did seem to make a very educated decision about having a home birth, though she rankled some people with her opinions in some areas. Haha, but that's what blogger's do, right?

Disclaimer: There is definite bias here--I was born in a hospital with a midwife attending, 3 of my siblings were born at home with an MD who did homebirths (though I believe he has since been forced to quit due to insurance issues), including my monster 11 lb brother, and my youngest sister was born with a midwife at home. A birthing center/CNM will also probably be the route DH and I take when we get to that point in our lives, insurance willing.

[medpedspouse]

I am pro what works for you and your family or situation. That being said, based on the bloggers post, I would have done the same as the OB/GYN. Heck, I'd stay away from her if I was her paper delivery person, plumber, banker, etc. From the way SHE describes how SHE handled the situation, I'd be running the other way. I am anti-drama queens.

[spotty_dog]

We clearly don't have the whole story here. However, taking the woman's description at face value, no, I don't think a physician should decline to see a patient because of her previous record of giving birth at home, or visiting a chiropractor for chronic pain, or any other "off the beaten path" but carefully considered and possibly even evidence-based choices.

I wish that as a culture we could work toward having more choices in birth. Normal birth at home with a trained attendant is as safe as birth gets. Nobody should be shunned or scorned for choosing that option, which also happens to cost less than hospital birth, so if more families made that choice we'd all be paying less for health care! But women who choose to birth in hospitals, or who require more medical management of their pregnancies and births, also deserve a more woman-centered approach than they receive in most US healthcare facilities.

The way you describe your bias, though, you kind of make it sound like a CNM-attended hospital birth is as "fringe" as a LPM-attended home birth, and to that I have to sort of disagree. Although it's not the most mainstream choice, a certified nurse-midwife is a highly trained medical professional *within* the modern healthcare system, much like a PA or an NP. They might not be the most common choice, but for normal pregnancy and birth, I think they really ought to be. (Whereas I think that home birth midwifery needs to remain a safe and legal option, but I'm not sure it is or will be the *most* common approach to monitoring pregnancy and assisting with births any time soon.)

[SoonerTexan]

Here was her first experience:

http://thatwifeblog.com/2010/05/the-gyn-appt-gone-bad/

I met her once briefly, and she really doesn't seem like much of a drama queen at all. Hardly intimidating or "loud mouthed"

The way you describe your bias, though, you kind of make it sound like a CNM-attended hospital birth is as "fringe" as a LPM-attended home birth, and to that I have to sort of disagree. Although it's not the most mainstream choice, a certified nurse-midwife is a highly trained medical professional *within* the modern healthcare system, much like a PA or an NP. They might not be the most common choice, but for normal pregnancy and birth, I think they really ought to be. (Whereas I think that home birth midwifery needs to remain a safe and legal option, but I'm not sure it is or will be the *most* common approach to monitoring pregnancy and assisting with births any time soon.)

No, I completely agree. I've just seen the judgments, looks, etc. from family and random people my mother used to get and sometimes still does. A lot of people view anything other than a pure-hospital birth as completely insane (my in-laws included--the next few years should be fun), which makes me a wee bit wary about posting it

Probably because of my mom's experience, I've always found the subject fascinating. I even chose to explore the whole midwife-->OB historical transition for my History Undergrad Thesis and the story really is fascinating. It played out extremely differently in various area/nations largely depending on how much regulation and education was provided to midwives. Sadly, the US did a horrible job. It's also interesting how far back the MD/Midwife "war" goes.

[migirl]

I vaguely remember having a similar discussion about this topic a few years ago, but what really stuck with me was Sally's (mommax3) assertion that - during labor and delivery - when things go wrong/badly, they can do so VERY quickly and it's in those situations that being in a hospital or similar medically-equipped environment can be invaluable.

I guess I don't really care how women want to give birth. At home, in the hospital, in a barn ... whatever you want to do is fine with me. For me, with the medical issues I tend to have during L&D ... a hospital is pretty much going to be the only way I'll go.

[rainbabies]

I didn't read the article...and I prolly won't, but I say whatever you do...is your decision. Just like bf-ing and circ. But like migirl said, things can go very wrong very quickly. So, if it's a decision the parents make, awesome for them. (really!) just don't sue my husband when he can't save you or your baby if/when that bad thing goes wrong, bc of a midwife/parent decision.

....and let the stones fly....

[DCJenn]

Most of the women in my crunchy 'hood have given birth at home. BUT, we're also at most a five minute drive to the closest ER, too. I do know that when the most recent neighbor was laboring and delivering at home my husband was incredibly nervous. He was pacing.

Jenn

We clearly don't have the whole story here. However, taking the woman's description at face value, no, I don't think a physician should decline to see a patient because of her previous record of giving birth at home, or visiting a chiropractor for chronic pain, or any other "off the beaten path" but carefully considered and possibly even evidence-based choices.

I agree with this -- especially the part about not having the whole story.

Doctors are not drug dispensing machines, and the whole "please just write me a prescription for birth control" facet of it really rankled me. My guess is that the doc was surprised that she'd given birth at home, and she is clearly sensitive to the issue and may have overreacted (and his surprise may very well have been rather incredulous and well, it doesn't take much to set any of us off when we're 9 weeks postpartum). He's got to ask the questions, and she can't just say "I don't want to have this discussion because I was lectured by my last provider for my choices." He can't / shouldn't treat a patient for whom he doesn't have a complete H&P, and I don't blame him one tiny bit for walking away. ESPECIALLY in this crazy, litigious society -- one that affects ALL docs, but possibly affects OB/GYN's the most.

I think people should have options when it comes to how to have their babies, but I also think that people who choose to do it at home shouldn't be able to sue the doctor they end up seeing when everything has gone in the crapper from waiting too long at home. THAT won't happen anytime soon, so in the interim, I don't blame OB/GYNs for being incredibly touchy and picky about who they will treat.

[spotty_dog]

For me and my family, my husband knows too much about the one in a million complications that would *only* be saved with immediate access to hospital-level care. That made the hospital decision the right one for us despite my homebirth sympathies. But I think it's completely reasonable for someone to do a pure risk-benefit analysis and say, "A one in a million complication would be tragic, but I'm going to take that risk with my eyes open."

But the one in a hundred, the one in a thousand complications? Most of those really do OK with a trained attendant who knows the warning signs and knows when to transfer, and/or can begin treatment immediately. Home birth doesn't have to mean forgoing all medical care, especially in an emergent situation! I do think some of our OB spouses have seen the aftermath of poor midwifery -- in particular, in states where attending an out-of-hospital birth is illegal, midwives can be really reluctant to seek necessary care, and if no provision exists for licensing homebirth midwives, then it's hard for the layperson to determine their provider has a basic level of training. That's one reason why I say that I feel that safe legal homebirth needs to remain an option. :\

[Pollyanna]

I didn't read the article...and I prolly won't, but I say whatever you do...is your decision. Just like bf-ing and circ. But like migirl said, things can go very wrong very quickly. So, if it's a decision the parents make, awesome for them. (really!) just don't sue my husband when he can't save you or your baby if/when that bad thing goes wrong, bc of a midwife/parent decision.

....and let the stones fly....

Amen!! Dh has delivered several dead babies because the mothers chose home birth when they had no business doing so. It amazes me to see the contempt some women have for OB/GYNs/hospitals. When my dh suggests you have a c-section/epidural/pitocin/etc. it is actually because he wants what is best for mom and baby. He always tells patients that the goal is a healthy baby and a healthy mommy, if it can happen with a 25 page birth plan he is on board but if baby or mommy is at risk he will do what is medically necessary even if it wasn't part of a "dream birth experience".

[SuzySunshine]

I had two hospital births, one that went as planned and one that did not that is my bias. I have two friends that had terrible experiences one with a home birth gone wrong and one with a midwife birth gone wrong in a hospital. The later will never be able to have another vaginal birth because of the tear that she had and the care she did not receive immediately and she had to go through extensive physical therapy. She was not happy about having to go see a gyn surgeon afterwards but she had to get help, the surgeon was caring but was also very clear that he would only be able to help her if it was clear up front that he couldn't guarantee he could "fix" her and that she would most likely never be able to have another vaginal birth. The friend with the home birth is having her second in October and I'm not sure what she has decided to do, the first was very traumatic for her and she doesn't have anything against doctors she just wanted to do it her way.

I have to agree with Shakti, in this day and age any physician that doesn't have a full medical history shouldn't be writing anyone a prescription for anything. Every doctor/patient interaction is a he said/she said unless there is a nurse in the room but if this patient wasn't willing to answer basic questions she had no business getting a prescription for anything.

[MrsK]

My SIL, who does not have children, tried to persuade me to have a home birth. She believed that doctors give pitocin and perform c-sections to make money. I had my first baby at 35. He was frank breach. And early. And my doctor sent me for an emergency c-section when an in-office ultrasound showed my AFI was less than 1; apparently my water had been leaking very slowly for days. There is no way in heck that baby would have come into this world safely if not for very careful monitoring and a hospital birth. My other SIL had a pulminary emballism when her first baby was born and she spent weeks in the ICU. So, that's my bias. As for a birth plan, I wouldn't have cared if my doctor recommended taking the baby out through my navel. I hired her for her expertise and deferred to her entirely. Nevermind whether I had my fantasy birth experience. The goal was to have a healthy baby and a safe delivery.

[Deebs]

I could write about this for a long time. I worked in Quality Assurance for a long time, and saw many bad outcomes as a result of home birth. I also have a sister who labored at home for nearly 50 hours (with a midwife attendant the entire time, as well as her DH who is a chiropractor and therefore claims "trained" in OB/Gyn because of his three years of chiropractic school) before my mother begged her to go to the hospital. Both mom and baby nearly died and all she and her DH could do was complain that they had to go through the ED for care (because she was under the care of a midwife, and not and OB). I realize that for every bad outcome I saw in my work experience, there were MANY successful homes births.

Getting back to this, though - the biggest problem I had with the whole thing was that she listed his name on her blog. If this were my DH in the ED, where many of his patients leave dissatisfied regardless of how good their care was or was not, and a patient of his listed his name in a derogatory manner such as this, we would be contacting our attorney. I don't think it's appropriate for this woman to walk in to an OB's office in the postpartum period and demand drugs. IMO, that is exactly what she did. To me, it's no different that a patient walking into the ED and saying they demand Dilauded (which happens all the time), and expecting to get it.

[SoonerTexan]

I guess my biggest interest was how you all felt about the Gyn's decision to not even see her because she had a home birth and did not want to be lectured about it. To me this doesn't sound like she was "demanding drugs" if she asked him to finish the appointment.

"Anticipating what was coming I told him that I had switched from a previous provider because I had been lectured on my choice to birth at home and that I was just there to get some birth control and would appreciate not receiving a lecture on my choices. He gathered up his stuff and opened the door, and I asked him to please stay and just write me a prescription for birth control because that’s all I wanted. He told me I was free to leave whenever I wanted and I asked one more time if he would please just stay and finish the appointment. He refused and left."

Haha, I hope I didn't open up a can of worms. When it comes to Home Birth/Birthing Centers/Hospital births I don't believe there is any one right choice, but just believe people should be more open to the non-mainstream choices of others. Also, though this wasn't really the intent of my post, I would like to make it clear that at the first sign of any complications, I would transfer myself to the care of an OB/Gyn immediately during pregnancy or birth.

[SuzySunshine]

I guess my biggest interest was how you all felt about the Gyn's decision to not even see her because she had a home birth and did not want to be lectured about it.

But this goes back to the he said/she said - did he refuse to treat her because she wouldn't even answer basic questions and therefore really only wanted him to write her a scrip?