Hi all.  I'm pregnant with my second, and want a homebirth.  I'm looking for a midwife, and was planning on also using an OB as the "back-up" and doing appointments with both since I think then insurance will cover the bloodwork, etc, if the OB does it.

But now I'm wondering if I need to see an OB after all... and wondering what that means.  Here in CA I don't think OBs are allowed to technically be "back-up"s anyway, due to malpractice insurance.  It would be so much simpler to just see a midwife...  but I've already had one appointment with an OB, and one worry is, what will their reaction be if I don't follow through with care with them? This sounds a little crazy I know, but can they accuse me of neglect if they think I'm not getting proper prenatal care (even though I would be, just through a midwife)?  

Ok, I'm rambling, my main question is, what did YOU do-- did you see both a midwife and an OB, or did you go with just the midwife? If so, what was your plan in case you needed a hospital transfer?


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Hi Marcy,

I think your questions and concerns are very understandable and completely valid. I can relate.

During the first 4 months of my pregnancy, I went the "normal" route of prenatal care at a local hospital. Then between 5-6 months I hired a home birth midwife and began home visits every two weeks with her. But I didn't stop going to the hospital for care.

I didn't tell the midwives at the hospital that I was planning a home birth. I just kept going full steam ahead like everything was normal, including signing a water birth consent form. I didn't do this with the intention of birthing there, I did it to be thorough.

When labor began, I just didn't go in. I stayed home and gave birth to my daughter on a mattress in the birth room. No one at the hospital ever called either.

My fiance and I thought it having care both by our midwife and the hospital was a good idea at the time (my first birth). The hospital was there for us just in case, as our backup plan.

You could do the same thing. But it's up to you. If you feel like you don't really need to continue seeing your OB, I understand. At the same time, if you want to continue seeing your OB and in the case of transfer, still have his/her support, (without the knowledge of your home birthing plans) I completely understand that too.

Hope that helps! :) Good luck!
Hi Marcy,

I'm 35 weeks and originally chose an OB who also has CNMs. I had a difficult time finding a home birth midwife, so I was under the care of the CNMs until around 30 weeks. Then I got a great referral to a home birth midwife and found out that I would be able to give birth at home after all. My husband and I love our midwife! After just 2 visits, we felt more comfortable with her than with the CNMs we had been visiting for months.

I had originally planned to tell my OB/CNMs at 32 weeks, when I had a scheduled ultrasound. But, since baby was breech at the time, I decided to wait and continue to see both just in case I ended up having to have a hospital birth after all. But, since baby has turned and we continue to have no complications, I really don't feel like continuing to see both my home birth midwife AND the OB/CNMs - especially since we are going to start the weekly checkups soon.

So, I've pretty much decided to cancel my 36 week appointment and not make another appointment. I'm thinking about writing my CNMs a letter explaining why I'm leaving the practice. The CNMs were very nice and were definitely better than the OB I had for my first pregnancy/birth. But, they simply don't compare to the quality of care with my home birth midwife. I think they will understand. What I don't know about is how all my prior visits will be handled for payment and insurance... So, that is the big unknown for me.

If end up having to go to the hospital, I will be going to a different hospital for my birth than the one my OB and CNMs have privileges at, primarily because my home birth midwife has had better experiences (and it has better reviews) with this hospital than the one I was originally planning to use. I figure that the primary reason I would be transferring is for an emergency c-section or other emergency and having a back up doctor will really be rather moot at that point anyway - whoever is on call will be the one taking care of me and our baby.

So, that is my experience and plan so far!

Oh, and regarding accusing you of neglect - some aggressive doctors may try that as a scare tactic. But, it is perfectly legal to receive care in your state from a midwife. At least in my experience, the midwife provides better care - more time, more comprehensive, less invasive care. So, any doctor who accuses you of neglect would be completely out of line and, legally, could do nothing anyway. So, don't let that worry you! Do what you feel is right, even if you have some uneducated opposition. :)

I have always felt that being at home would be best for me but when we finally started trying I got worried.... I kept thinking that I would get in trouble, or that they would take the baby if I gave birth at home.... (I have since gotten over these feelings) I just saw it as my mind reacting to what society has pushed on us as women. I went to a local OB, as "back-up", he was so rude and refused to answer my questions that I will not be going back (I know not all OBs are like this). I just am so in love with our midwife and feel so safe and secure with her that the thought of having a "back up" and unnecessary appts. is too hectic and complicated for me. My husband and I have talked about it and on the chance I would be transferred it would be an emergency situation anyhow, so whoever was on call would see me and it wouldn't matter who I had appts. with or not. Best of luck to you! Xoxo
Hi Marcy,
I started with an OB until they kicked me out when I was honest with them and told them I was "considering" a home birth. So my advise would be DO NOT tell your OB if you are considering a home birth. It will at least give you the options you deserve until YOU decide what you'd like to do. I am very happy with my midwives but I have to say it was very devastating to be told I was not allowed to continue my prenatal care with my OB because of their "malpractice insurance" and therefore was forced to make a decision quickly. I even told her at the end.. "it really is horrible that I was honest with you and next time, I won't be".
Most OB's cannot be backup's so what I would do is when you find the midwife you love, ask them who they use for the back up and meet them. It will all work out perfectly.
Thanks, everyone! I think the thing to do will be to wait till we move and find a midwife, and ask them about recommendations for doctors and how transfers have worked for them, with women who did and did not see an Ob up to that point. I have a slight worry about how I'd be treated in the hospital if I didn't have a medical record with them (have heard horror stories) but that will depend on the specific hospital and I'll be able to find out what the tendencies are from the midwives. Then I'll have to decide... one aspect might be that insurance will cover bloodwork and ultrasounds if I do them thru an OB, so might keep up the appts just for that. We'll see...

Again, thanks for all the responses!

I picked an in-network provider OB office that also has CNMs and had all my blood work and ultrasounds through them, even as I was seeing my home birth midwife. That worked very nicely (insurance covered everything). I had all my paperwork/results faxed to my midwife. I just told the OB office that I had supplementary care with another provider and they didn't ask any questions.
As long as you are seeing a qualified midwife or nurse midwife who is providing you with pre natal care that you feel comfortable with there is no need to see an OB. Ecspeacily if you are not high risk. There can be no law suit against you for neglect if midwifery is legal in your state. You are simply choosing alternative care. If your OB is ethical and professional he will support your decision. You can let him or her know that if a midwife discovers that for some reason you need to see an OB that they will be that person. This is your decision, no one elses.
I am seeing a midwife and am 34 weeks. This is my third birth. I had the first two with OB's and in a hospital. This one will be a home birth. I feel that the pre natal care I've recieved thus far have been better. I look better this pregnancy, I have more energy, and feel quite satisfied with my midwives. I hope the same for you.
With my second baby (first home birth) I saw the doctor I used with my first baby until 26 weeks, when I switched care to my midwife. I also moved at the time, so I told him that was the reason I was leaving. With my third baby, I saw a home birth supportive family practice doctor and then switched to home birth 4 days before my baby was born (LONG story).

With my fourth I only saw my midwife. With my fifth I only saw my midwife for prenatals, but I saw my home birth supportive family practice doctor when I got a horrible migraine and when my kids all came down with Fifth's Disease (I'm not immune). She would have been my care provider had I transferred (she's taken my midwife's transfers before, too).

So, for a normal pregnancy, I only see my midwife.
I did not see an OB at all during my last preganancy. My midwife was able to order any blood work or ultra sounds and there really wasn't anything that I felt I needed a doctor for.

My thought is that if you know you want a homebirth, then a possibly unsupportive OB is just a hinderance. Why set yourself up for any negativity? As far as a possible hospital transfer - if it gets to that point, it probably isn't going to matter to you who you see, because that would be an emergency situation and you would just want some one to do what needed to be done. And, as some one already said, the chance of you just getting the dr on call is pretty high, even if you have your own OB. I would, however, make sure that your midwife would come with you as a support person.

Oh, and as far as following through with your current OB - just don't go back. I don't think that is something you need to explain.



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