Alta Bates OB open to Homebirth

I am hoping for a homebirth in July. We've found a great midwife and are now looking for a new OB (and pediatrician!) in Oakland with privileges at Alta Bates. I'd like someone to have access to my health history, in case the birth doesn't go smoothly and I need to transfer to the hospital. Also for continued care after the birth. Any recommendations on a doc who won't balk at queer/trans parents birthing at home? (switching insurance at 6 months pregnant, yikes!)

I thought the dynamic of the midwife/doctor relationship in this area to be odd because we had our first son in Los Angeles where the relationship between the two was better. In LA, there are very few but a handful of doctors that midwives can rely on and be honest about the situation with and that doctor is then considered your backup doctor. Here, where I'd expect it to be a better dynamic, it's not. Our midwife told us if we told a doctor here no doctor would see us. We're two moms, by the way, and we've had no doctors or hospitals treat us any differently/poorly because of it. It could be that we lucked out but I think hospitals have seen it all and this is California (so we're protected more than most states) so they're fairly open to non-traditional situations. Good luck and congrats! albanymama

Kaiser OB who supports home birth?

I am early in my 3rd pregnancy and am most likely planning a home birth. Some of the BPN archives seem to say that an OB can ''drop'' you from their care if they know that you are getting concurrent (private paid) care from a midwife in preparation for home birth. I had planned to use Kaiser to get all of my labs and bloodwork and testing done since it would all be covered under my insurance, but I am worried my OB will refuse to write the orders for such things if she knows I am planning a home birth. Somehow this seems illegal to me in some way. If I'm covered by Kaiser insurance, don't they have to allow me to use my insurance for costs that are allowed under my plan, regardless of where I choose to deliver this baby? -Wish Kaiser covered home birth

Homebirth-friendly OB Gyn

I'm newly pregnant and am hoping to have a home birth with a midwife. I've identified several great, potential midwives from previous discussions. I'm wondering, though, if any of you have had experience working with an OB/GYN who was happy to continue seeing you as a patient after you had a home birth. (I understand it's probably best not to tell your OB/GYN from the get-go that you're planning to have a home birth, but they're going to find out sometime.) It would be especially great to get recommendations for doctors who are part of the Sutter East Bay Medical Foundation group, but others are welcome, too. expecting

Birth at home, prenatal with OB?

At a recent annual exam with my OB-GYN, I mentioned that I'd like to get pregnant in 2008, and that although I'd like to give birth at home with a certified nurse midwife, I'd like to continue to see my regular OB for prenatal care, in tandem with the CNM. My OB said that once I'd chosen a homebirth, her practice's insurance would no longer allow them to see me for prenatal care.

I guess it makes sense that people intending to give birth at home have their prenatal care with the midwife. Do the midwives handle routine ultrasounds, blood tests, glucose tests, all those standard tests I remember from my first pregnancy? I'd like a check-up that lasts longer than an OB, so a midwife would be cool that way, but I also appreciate the scientific expertise of the establishment!

I don't want anyone to tell me how to GIVE BIRTH, but I would still like to have my pregnancy monitored medically. I guess I'm afraid that a midwife check-up would be too touchy-feely or ineffective. Am I wrong? Any suggestions? Conflicted

Don't be afraid. Get a good CNM and enjoy your pregnancy. If all medical care were this good, I'm guessing we'd be a much healthier country. Laura

Then you once you do that you've got several options.

Option one is to stay with your OB and switch late in the pregnancy. The disadvantage of doing this, is that you don't get that time for bonding with your midwife that most homebirthers want.

Option two is called ''concurrent care'' meaning you stay officially with you OB, and pay your midwife out of pocket for prenatal care. DO NOT TELL YOUR OB you are doing this. With our first pregnancy our OB suggested that he would be happy to do concurrent care and have us change officially in the third trimester, then when his partners found, we were dimissed from the practice.

The third option is to pick a medically minded midwife, and they do exist. Certified Nurse Midwives are trained as nurses first, and are part of the medical establishment. If you ask around you will sometimes hear midwives described as ''medwives'' and those are the folks you probably want to talk to. I would seriously suggest that you talk to Amrit Khalsa, who worked originally as a Labor and Delivery Nurse, and I'm sure could accomodate you.

Whoever you interview, be honest about your concerns and if they are not supportive then they are not the right provider for you. In terms of what midwives do, it varies but almost everyone will check your blood pressure, your urine, measure you, and assess your overall health with more thoroughness than an OB will do, because they spend more time with you. I'm in midwife care, and I've chosen not to do most prenatal screening,(which I wouldn't do no matter who was caring for me) but I've had routine bloodwork, two ultrasounds (the nuchal screen and the level two test) and I have had a gestational diabetes test, and the option to do other testing, plus really excellent and thorough explanations of what the tests mean, and how they operate, not just ''everything looks good''.

It's definitely not an either/or decision, but a question of finding the practioner who meets your needs. Good luck. Doing it at home

-I WOULD pre-register with the hospital so that in case you do transfer to hospital during labor, they have a record of you.

-Homebirths cost between $4000.00 and $5000.00 and if you have a PPO, most all PPOs will cover about 70% of the cost (after deductibles). BUT, if you are going to continue doing OB prenatal care, the insurance company may wonder why you are in the care of two similar careproviders and will only reimburse one and not the other. For my 1st birth, I was lucky - my PPO reimbursed me for BOTH my OB's bills and my midwife's homebirth bills. But, for my 2nd birth, a different PPO took a year to reimburse me for my midwife's bills - and this was just the bill for the actual birth, since it had already reimbursed the OB practice for the prenatal visits. You have to be PERSISTENT with the insurance companies; they only reimbursed me after I hinted about seeing a lawyer regarding my legal and entitled reimbursement, this after a YEAR of calls and letters.

-Keep in mind that while homebirth midwives can do the glucose (gestational diabetes) test, other blood tests, the urinalysis, the vitamin K shot for baby, etc. they may not be able to get you an order for an ultrasound if you want/need one. It has gotten harder to do this but I think East Bay Prenatal in Oakland will still do them for homebirth midwives. This is why continuing prenatal with your OB/Hospital CNM is useful.

- You mentioned that you are thinking of doing a homebirth with a CNM. Why not switch OB practices and do concurrent care with a hospital CNM (Lindy Johnson or Hsiu Li?) and your homebirth CNM? You may still have to keep your homebirth plan to yourself, but you can ''feel her out'' and test the waters - say, mention homebirth and see what she thinks about them, etc. A hospital CNM will be able to order ultrasounds, etc. for you. Homestyle Midwifery used to do concurrent care for homebirth mothers; they were based at St. Luke's in SF but may have moved.

You CAN have your homebirth and still get some prenatal care from a hospital-based practice. You just have to think of all the logistics. Good luck, and congratulations! homebirth fan

Another reason for prenatal care with your midwife is that the midwifery model of care is qualitatively different than the medical model, which you will feel throughout your pregnancy. It makes a really big difference to have your questions answered with unbiased information from a practitioner who sees pregnancy & birth as natural processes rather than problems waiting to happen, and who respects you and honors your choices. As an example - when we told our midwives we had concerns about ultrasound and didn't know whether we wanted to do it, they gave us information about why people choose it, why people don't, when it is helpful and when information can be found through other means. I felt no pressure to choose one way or the other, and also knew that they were monitoring me in other ways and would recommend it if there were anything abnormal that needed closer examination.

As for routine procedures, yes, midwives perform many of them themselves (monitoring baby's heartbeat, blood tests, glucose, rhogam) and will refer you for others that they don't do (ultrasound or other invasive tests.) Interestingly, you'll find that midwives have greater expertise in non-technological methods - such as palpating baby to find position - than doctors usually have, and thus have more tricks up their sleeves to assist your labor without resorting to technological interventions. They actually have more experience with the many variations of normal birth than doctors do.

One distinction that you may want to be aware of - with this pregnancy I worked with Licensed Midwives (LMs) rather than CNMs. My first birth was with CNMs at a birth center, and while it was beautiful in many ways, I now see how my care in the birth center was less personal and more medicalized than it was with Homebirth LMs. Also, this may just be a quirk of my insurance company, but they say they will cover birth with LMs but not CPMs, which you may want to check out with your insurance.

I recommend ''The Thinking Woman's Guide to a Better Birth'' by Henci Goer, and ''Ina May's Guide to Childbirth'' by Ina May Gaskin, both of which will give you a sense of the benefits of working with midwives. Also, the Bay Area Homebirth Collective holds monthly Birth Story Potlucks - where you can hear stories, meet homebirth midwives and families, and get your questions answered. FYI, I worked with Abigail Reagan & Sue Baelen, both a part of the BAHC, and recommend them wholeheartedly.

Throughout my pregnancy, birth & postpartum period, I have gotten better care, information and support from my midwives than I ever have from doctors. I have also been empowered to take complete responsibility for my experience and my choices in a way I have never experienced with doctors. For this reason I chose not to have concurrent care with a doctor, and was never disappointed with that decision. Annemarie

I had my first child in a hospital with a midwife/OB practice in SF. It went very smoothly and I felt supported for the most part by all the medical staff. There were moments when nurses tried to instill different plans (monitoring for monitoring sake) and encouraged an IV ''just in case,'' but that might impede my moving around. We were able to personalize the room a bit, but it was quite sterile. In between baby one and two, I had a miscarriage and some other medical issues. I was appreciative of the advantages of modern medicine, but also quite conscious of how de-personalized, sterile, and interventionist it can be too. When I got pregnant again, the last place I wanted to be was a hospital.

My second was at home with midwife Amrit Khalsa here in Berkeley. She has over 25years of experience delivering babies and has more ''scientific expertise of the establishment'' than many OBs. I loved it. I felt safer, more supported, much more informed throughout the prenatal process and coached in this amazing process. This cannot be emphasized enough - information in a useful way and true support and attention is so much more than ''touchy feely''. Because of my insurance (PPO) and my relationship with the OB/midwife practice of birth #1 (who were no longer doing deliveries), I was able to do some basic prenatal care through them that included ultrasound and various bloodtests. I did not feel like I needed anything from the OB, though, other than an office to run the tests through so insurance would cover it. Amrit read all the results and was more than proficient in appropriate protocol for dealing with any anomalies. She also paid attention to aspects of my ! health that few health care providers had ever asked about (diet, sleep, relationship, household cleaners, ...)

But this is a big choice - it's a significant philosophical difference in care, attention and personal responsibility. Be prepared for lots of opinions about how you should manage your health and that of your baby, and look inside for what will work best for you and your family. You'll know what to do and what is important for you. JV

to my knowledge i don't believe that most midwives will only see you for the birth and not participate in your prenatal care and i don't think that CNM's do homebirths, only lay and licensed midwives. i could be wrong, but this is my understanding. if you have any questions, please feel free to email me. best wishes, mazu

First - What is a Certified Professional Midwife (CPM)?

A Certified Professional Midwife (CPM) is an independent practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The NARM certification process recognizes multiple routes of entry into midwifery and includes verification of knowledge and skills and the successful completion of both a Written Examination and Skills Assessment. The CPM credential requires training in out-of-hospital settings.

-What is a Licensed Midwife (LM)?:

A ''licensed midwife'' is an individual who has been issued a license to practice midwifery by the Medical Board of California. Licensed midwives, who have achieved the required educational and clinical experience in midwifery or met the challenge requirements, must pass the North American Registry of Midwives' (NARM) comprehensive examination. After successful completion of this examination, prospective applicants are designated as a ''certified professional midwife'' and are eligible to submit an application for California midwifery licensure.

In other words, most non-CNM midwives will be NARM certified as a CPM, but only once they pass the State Board exam can they become Licensed Midwives, something one must be to legally practice in California.

- What is a Lay Midwife?:

The term ''Lay Midwife'' has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife credential was available).

-What is a Certified Nurse-Midwife (CNM)?:

A Certified Nurse-Midwife (CNM) is an individual educated in the two disciplines of nursing and midwifery, who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives. And yes, many CNMs choose to provide homebirths, as some CNMS do in the east bay. It's just that more of them work in hospital settings than homebirth settings. There are also some LMs who work in hospital settings (there used to be some at SF General), but most provide homebirths.

Lastly, I noticed that the poster whose midwife was Judy Luce said that ''most of them (i.e. midwives) advise you not to tell your ob/gyn because of the reaction you got''. I'm not sure if this was her personal experience but I have to strongly disagree with this. I'm an apprentice midwife who works with a local licensed midwife here (AND I know Judy personally), and I'm sure most of the midwives in this area will NOT advise you to NOT tell your other care provider (e.g., OB) of your concurrent care or your planned homebirth - midwives, as medical professionals, will explain all of your options to you but they will leave it up to the mother to decide what is in her best interest. I would hate to get a homebirth midwife ''in trouble'' because of what this poster said, or to have other medical professionals who are part of BPN believe that midwives are giving this kind of advise to their clients. They're not. My midwife/preceptor, for one (and she is not alone), will give her clients extensive information on their many options - be it regarding a blood test or regarding the benefits/drawbacks of hospital or homebirth or concurrent care - and will leave the decision to the clients. Many homebirth clients often end up choosing to keep quite about their planned homebirths to their OB, but this is different from saying that the midwives are telling them to do this. 2-timer homebirther

Should we tell our OB we're having a homebirth?

My partner and I have started thinking that we'd like to try a home birth and use Alta Bates as our back-up but it seems that there are some complicatiins about that. Specifically, if we tell our ob-gyn, who we like a lot, that we're doing a home birth, then she and the other members of her practice no longer become who get called if we end up coming to the alta bates. Instead we would end up with whoever was working labor and delivery. If, on the other hand, we don't tell our OB but just end up coming in in a ''transport'' then this might make a few of the doctors in her practice very upst, and who wants to go through labor with a doctor who may be angry at you?! Still it seems wrong to give up the hope of a home birth because of these complications. And it's too late to switch to working with any of the Alta BAtes midwives. Has anyone else been through this? What did you do? Thank you!

Furthermore, having had three children, I feel that the birth process is not the main point in all of this. The main point is the child. I belive the extreme focus on the exact wishes of the mother at the time of giving birth are misplaced. They are a final attempt to hold onto control as you move into one of the most primal moments of your life. You will not have the control you have in other aspects of your life during the birthing process, nor will you ever have control of your life in the way you have had it before. So, perhaps you can give yourself over to this reality before the actual birth and accept that an in- hospital birth can be OK, or that a home birth backed up by whomever is on call is OK. The birth is one half of one day (more or less), and the child is for a lifetime. To start your child's life in the context of a deliberate deception of the very people who are committed to your care seems very inaspicious to me. Grateful to my OBGYN

In any case, it's not all that likely you will be treated by your OB if you give birth in a hospital anyway. I gave birth to both my children at Alta Bates and my OB wasn't at either of my children's births - nor were any of the 6 or 7 OBs in their practice! I asked one of the docs in the practice how many patients she treated that she actually delivered, she said about 30%. My advice: go for the home birth. anon

As to your question, though, about how to get your homebirth and your own ob/gyn back up just in case- I really think you need to decide what is negotiable and what is not. When in labor, especially if there is some danger or concern that would prompt a transport to the hospital, the last thing that I would want to deal with is keeping track of lies, omissions of truth, etc. At the end of the day, all we really have is our integrity, which for me is an alignment of my values and actions. Good luck! JV

Ob Gyn who is open to home births?

i am looking for an ob/gyn with pacificare hmo who is open to or at least tolerant of homebirth. i live in emeryville, so anyone in the general area would be ok. ideally, the dr would be willing to be a medical back-up if needed.

Ob Gyn open to home birth, acupuncture and herbs

I am trying to get pregnant and think my OB/GYN doctor is okay. But I am very interested in working with an OB that is open to me using alternative modalities, such as acupuncture and herbs. I would like to find a doctor who doesn't want to put me on hormones straight away. I also may want to have a home birth and want to find someone who will support my decision with that as well. I would love to know of an OB/GYN in the Oakland/Berkeley area that fits that bill. Holistically Minded