Hello everyone. I could use some advice.


I'm 19 weeks pregnant (which came as a shock to my husband and I -- we'd been through years of infertility and were planning to adopt) and thus far have been seeing my gynecologist for my prenatal care. He's a wonderful doctor and so far has been supportive of my choice to have a VBAC, but as the weeks have gone by and I've been thinking what my hospital experience was like when I had my son (pitocin because I wasn't dilating fast enough, which led to a c-section, my arms strapped down and not seeing my son until he was all cleaned off and bundled up, then dealing with nurses who were totally unsupportive of breastfeeding), I've decided to skip the hospital altogether.


I've hired a homebirth midwife and am super-excited about birthing at home, but the hard part is that I have to tell my doctor. I would like for him to be my backup OB if I should need to be transferred (ugh!), and I will need to keep seeing him for gynecological care after I deliver (because I've had issues with abnormal cervical cells) so I want to make the break without damaging our doctor-patient relationship too much. Any advice on how to go about this would be much appreciated!


Thanks in advance.

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Why tell him? If you were not having a homebirth, you would go into labor and at some point go to the hospital to have your baby. Your dr would be called when you were ready and he would come in. Now, you have chosen a homebirth and hopefully that is exactly what you will get!! If things change and you end up in the hospital, they will call your dr when you get there. If you want your midwife present at the hospital, she can remain there as your "doula". If you have the baby at home, you just tell your dr that it happened fast and you didn't make it to the hospital. I know with-holding all of the truth is not always the best way to go, but why spoil and good dr-patient relationship if you do not have to. From my experience, dr's are not very supportive of homebirths. Wish it could be different in this day and time! Congrats on your pregnancy and good luck with your situation.
I would tell him, the worst thing that could happen is he might not "be able" to be the backup OB b/c of silly hospital policies. It depends on where you live. I had a HBA2C last summer, found a homebirth midwife at 30 weeks b/c I just couldn't face another c-section if I had this opportunity to avoid it (mostly because of the hospital experience we had with the first child, it made the delivery of the 2nd child very nerve wracking). I had considered doing parallel care (seeing both my homebirth midwives and the OB/GYN since I was determined to be a 100% surgical patient b/c of 2 prior c-sections). Hospital VBAC is not allowed in my area, so homebirth was the route we pursued to have a VBAC. The midwives at the hospital practice were quick to say "good luck finding anyone who supports your vision to VBAC", simply b/c their hands are tied when it comes to hospital policy. It wasn't too hard to find support, lol!
If this doctor is supportive of you desire to VBAC, then it should be a pretty open conversation. Tell him exactly how the hospital experience is molding your decision. I had great support and a positive reaction from my children's pediatrician who knew we were going to HBA2C, as he has know both older children since birth. He gives me props every time we come in for a well baby visit. The ladies at the reception desk were pretty excited to learn about our experience too and ask TONS of questions, I guess we are a rarity;)
Go for it, don't be afraid of the VBAC-let that past experience go, just commit to the decision and relax into the process, enjoy the pregnancy!
I am 30 weeks and contemplating how to tell my ob also. I have told him that I am also seeing midwives to complement my care so it is more rounded and comprehesive, so far he has been supportive I just haven't broached the homebirth part yet.
I continued seeing my OB while under the care of my midwife. My insurance was paying for my doctor so I figured why not, since that is why I pay for insurance. I did talk to my OB about the possibility of a homebirth. He told me he was worried about the ability of providing hospital care fast enough if I had to be transferred but was otherwise quiet about it. We never said for sure that we would go the homebirth route. After I had the baby, I simply called my OB and him know we had had the baby at home. I scheduled my postpartum visits and that was it.
If the OB is all don't do it then just don't bring it up again. I doubt they will refuse to treat you if you end up at the hospital and babies are born at home all the time on accident so I don't think a call to say the baby was born will be too shocking. Good Luck!
I'm in your boat too. I met with one midwife tonight and meet with another tomorrow.......what will I tell my OB. My issue is, if I'm not going to deliver with him, why go thru' all those exams during the last month????? I'm 31 weeks now, and I feel like it's time to get things narrowed down and go with it. I wish I tho't he'd be my backup if I had to transfer, but I really doubt he would.....I guess I'm not really giving him the benefit of the doubt. He's recommending that I have a (would be the first for me) csection, so I really don't think that he would approve of me having a planned homebirth.
Angela, why is your OB recommending a c-section? This is your first baby, or it would be your first c-section?
This would be my first csection. I have had three children vaginally :)
And he's recommending a c-section??? After you've birthed 3 other babies vaginally? Why? That's ridiculous. =(
because two of my children had "distocia", and that I tend to have big babies. Actually, the other day I called in and told the secretary that I needed to cancel my appointment and that I would be seeking care elsewhere for the rest of my pregnancy......I would be in touch if I need to transfer records......
I see my midwife for our first official visit on tuesday.
Dystocia as in shoulder dystocia where the baby got stuck and they had to use force to free it?

Or dystocia as your in labor was taking too long?

If it's shoulder dystocia then make sure you have a midwife who has loads of experience and attending rights at hospital in case you need to transfer, and contemplate having your birth in the hospital with the midwife as lead carer, or as your support doula to fend off the interventions. Shoulder dystocia can be a very big deal, and can cause permanent injury, including brain damage, and that's what your OB is worried about. (Including the fact that there are a lot of successful lawsuits for failing to perform cesareans for shoulder dystocia, and the baby is harmed, or the baby is harmed because of lack of O2 when it's body gets stuck inside after it's head has been born, or has a permanent brachial plexus injury.)

Sometimes you can get "bed dystocia" from pushing on your back, which is not true dystocia since it's caused by your position. It would be good to get your records to have more info.

If you are not happy with your OB pushing a c/s, get another opinion! Your midwife should be able to provide you with good recommendations for other obstetricians. You can have a midwife and an OB.

If it's just that your labours were longer with 2 of your kids then that is a ridiculous reason to push for a c/s, and lots of women give birth to big babies.
If it is indeed shoulder distocia that you have a history with, definitely make sure your midwife has experience using the Gaskin maneuver. From what I understand, shoulder distocia can be as simple to fix as turning the mother over onto her hands and knees to help free the baby (something that unfortunately is either not well known about in modern medicine, or just not possible when you're strapped into all the beeping machines and immobilized by an epidural...), but you'll probably want a midwife who's had experience with those situations.
If I understood him correctly, it has been because of shoulder dystocia. The labor with my first was long--but that was with another dr. and there is nothing in the records about her having any problem with distocia. My last two were born within 3 and 1/2 hrs of being induced with pitocin--they were both scheduled inductions.
I have read alot about the Gaskin Manouver. It would be my opinion that a big part of the problem was the position that I birthed in and all the interventions. i.e. the pitocin, and epidural, etc.
I have discussed my birth history in depth with four midwives and specifically asked "am I a good candidate for homebirth". They all answered that they believe I am.
At this point, I have picked a midwife from the ones that I "interviewed" and feel confident enough to allow myself to get excited :)



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