It Happened on the Way to the Midwife, Part 3.

Since this is the part where Dr. Miller gives me a sales pitch for himself (who is one of only three OBs in Ridgecrest) and the hospital, I think I should give you a few stats about the hospital.  They do not do VBACs.  Even though this isn’t a concern for me, it tells me they are seriously behind the times.  As of 2007, their overall c-section rate was 40%.  Their c-section rate for normal, low-risk pregnancies is 22%.  Compare that to 10% just two hours down the road in Bakersfield.  I have other reasons for being suspect of this hospital, but I think the statistics are enough to give one pause.
At this point, I’m pretty well shocked.  I had no indication that the meeting would wind up like this.  I wasn’t really sure what to say.  If he’s already made his decision, what point is there to arguing.  I’m hungry, tired, and ready to leave, but that wasn’t going to happen any time soon.  So I mostly tried to stay quiet and listen to his spiel until I could get out of there.
He starts giving me reasons he doesn’t do this.  He says (and I quote) “1 in 100 babies died before hospitals.”  I don’t have internet right now so I can’t check the accuracy of this statement.  But I do know that a statistic like that doesn’t apply to modern home births attended by professional midwives.  I also know that some of the darkest days of maternity care were the early maternity wards that were unsanitary.  Doctors didn’t even wash their hands and antibiotics hadn’t been discovered to treat infections.  But I digress.
He tells me he can’t be sure about some of the midwives “around here.”  He says that there are a lot of midwives in the area practicing without licenses or even any training.  In case you were wondering, my midwife is licensed by the state of California.  Since he has worked with her before, he should know this.  However, it’s fairly easy to check that kind of thing.  We do live in the information age, after all.
I think it was around this time that I finally interjected and told him that I wish he would have told me this over the phone so that I wouldn’t have had to spend an hour and a half waiting to find this out.  He says, “Well, we didn’t know what you wanted.”  Liar, liar, pants on fire.  I said, “Yes, you did.  I told the nurse on the phone that I was having a home birth and looking for a back-up physician.”  He didn’t really have anything to say to that.  Now, I know there’s a chance that this was a miscommunication among his staff, but if you have a hard and fast policy regarding home births, I would think you would communicate that to your staff.  But I would have to remind you that I left a message telling them what I was looking for.  I reminded them twice on the phone when I made the appointment.  And when the nurse brought me to the exam room, she knew what I was there for even though I hadn’t mentioned it that morning.  I never asked for a consultation on home births versus hospital births.  If I had known he wasn’t going to accept me as a patient, I wouldn’t have made the appointment.
I mentioned that I have a friend who had a home birth in May with my midwife, and he was her back-up physician.  He didn’t really have much to say to that either.  It seemed like he really wanted to pretend that this is always the line he’s walked, and he can’t remember ever doing anything differently, even if it was only four months ago.  He continued to act like he doesn’t know anything about my midwife. 
He says he doesn’t like backing-up home births because then he “misses out on all the fun.”  He says he likes to develop relationships with his patients.  He would meet my husband, and we would do ultrasounds together.  First, I never declined having a relationship with him.  In fact, I think it would be great to have a relationship with my back-up.  That’s part of the point, right?  So that if your care has to be transferred or you do have an emergency, it’s not a stranger working on you.  Second, I don’t want a bunch of ultrasounds, thank you very much.  They’re unnecessary and haven’t been proven to be completely safe.  Once again, the fact that he sees this as central to my care shows me that he is not be on the same page as me.
I mentioned that in Jacksonville, the midwives and the OBs work together so that you have a relationship with both (I could be totally off on that, but it seemed like it worked that way from what I saw).  He told me that Jacksonville is a big city, and they do things differently.  Thanks, I needed another reminder of why I hate Ridgecrest and miss Jacksonville.  I don’t really think I should have to sacrifice standard of care because I live in a small town.
I pointed out that some people who are planning a home birth also go to an OB but don’t tell the OB about their plans.  I told him that I was trying to be honest and upfront with him.  He told me he could tell when someone was planning a home birth.  Of course, you can.  (As a side note, I wouldn’t do that.  Part of the reason I’m going to a midwife is because I want joyful prenatal care that is in line with my beliefs.  But even if I did, I wouldn’t be with him because he’s not the OB that my insurance approved.  I’m certainly not going to pay out-of-pocket to be berated and treated like my pregnancy is a disease that needs to be cured.)
I think it was around this time that I told him I felt like I was wasting his time and keeping him from his actual patients.  That didn’t seem to concern him.
Then he offered to help me with a home birth if I did all my prenatal care with him.  I told him that was ridiculous.  Not that it’s something I would even consider to start with, but what midwife is going to do a home birth with someone who has received all of her prenatal care elsewhere?
He told me he wouldn’t charge me all the extra fees my midwife charges me.  What?  I’m paying my midwife a flat fee that covers all of my prenatal care, the birth, and postpartum care.  Maybe he’s talking about the cost of the birthing kit?  Yeah, that $60 is really going to put us in the hole.  Or the birthing tub rental?  Not required and wouldn’t be an option at the hospital.  I don’t know how much he charges, but I know that between OB appointments and the cost of a hospital birth, a midwife is a bargain.  Of course, why should I worry about that?  Tricare and the tax payers foot the bill for the hospital birth, right?
He told me getting a birth certificate would be easier.  And that’s the rubric by which I measure everything.  Sure, just go ahead and do a c-section.  As long as the birth certificate is easy to get.
He told me he could give me if I had nausea, he could give me a prescription.  Okay, this is another one of those “how different could our philosophies be” moments.  First of all, I already told him my morning sickness was mostly over.  Secondly, I don’t even take Tylenol for my headaches or Zyrtec for my allergies.  I don’t do prescriptions unless it’s a continual quality of life issue and even then, not during pregnancy unless it’s absolutely necessary.
He said he could help me pick out a pediatrician.  I informed him that we have Tricare Prime; my pediatrician is at the base clinic.  “You don’t get to choose?”  Um, no.  That’s how Tricare Prime works.  (Besides that, I have a two year old.  Shouldn’t I already have a pediatrician picked out???)
I think by this time my face was red, and I was shaking.  I was incredibly frustrated with him.  He told me I was just upset because I wasn’t getting what I wanted.  It’s at this point that I started having flashbacks to my pediatrician who used to diagnose my stomach problems and severe allergies as “schoolitis.”  If you want to treat a seven year old like a silly little girl, that’s understandable.  But I’m a twenty-nine year old, college educated, second time mom; I think I deserve a little respect.
Then he told me I should go home and discuss it with my husband.  I informed him that my husband is 100% behind my decision to have a home birth.  He said, “Well, I’d really like to talk to your husband; I respect what he does.”  That was the point where I blew my top and left. 
I know that some of this may seem inconsequential, but it was really upsetting to me.  I was not interested in being sold on the hospital or transferring my care.  I wanted to add him as part of my birthing team.  What really irritates me is that it all could have been avoided.  If he doesn’t back home births, he shouldn’t have made an appointment with me.  I feel that if nothing else, he was deceitful and treated me like I was an idiot.  And maybe because I didn’t really feel like spending my morning chewing the fat with a doctor who just declined me as a patient, he didn’t get the chance for me to prove him wrong.
I still feel that a home birth is the best chance I have for a safe, natural birth, and that’s what I’m doing.  But I am deeply disappointed that I have to do it without a “back-up plan.”  I was already uneasy with of the thought of having anything to do with Ridgecrest Regional Hospital or the OBs associated with it, now I’m terrified.  It is really unnerving to have to spend the next two and a half years of my life in a town where going to the hospital is such a scary prospect.

 

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5 Comments

  1. Sexist a$$hole is what keeps going through my mind with this guy (“I'd like to talk to your husband”… I didn't know he was pregnant!)

    The likelihood of you ending up being transferred is so minuscule that you should just put it out of your mind. Concentrate on taking care of yourself and the baby and prepare for your home birth. Worrying about the hospital is like wasting all your time worrying about a c-section. They just get in the way of you enjoying your pregnancy and getting excited about the upcoming birth.

  2. Great blog, Brandy. I did want to make one comment though. I had three of my four babies at home and I received prenatal care with an OB and used the midwife for the birth only. Now in the case of my first home-birth, I saw the midwife 2 or 3 times b/c other friends here in Ridgecrest were also pregnant, due before me and using her. With my second & third home births I used a local lay midwife who is a friend of mine so I did already have a relationship with her.

    Since we are military and using TriCare, midwifery care was not a covered expense and we couldn't afford the full fee for prenatal care and birth so we were able to negotiate a price that worked with our budget and that incluced using an OB for our prenatal care.

    While I understand what you are saying — it's important not to just have your midwife appear to catch the baby — there are some women who do actually do all their prenatal care with an OB and only use the services of a midwife for the actual birth and it can work out really well. I did meet with the local lay midwife one or two times between 35 weeks and when I gave birth (38 weeks and 37 weeks) and I would talk to her on the phone and let her know how things were progressing as per the OB appointments.

    My OB was fully aware that I was having a planned homebirth and that I would stop seeing him at 35 weeks and he was okay with this. It was not Dr Miller; however, he had offered to be the back up for my lay midwife. The OB I did prenatal care with would've attended to me if we'd needed to transfer; however, in the case of a mother who had done all her prental with the midwife, Dr. Miller would've been the one to attend to her if she should transfer.

    It's really disheartening to hear that he's changed his mind. I'll ask to ask my lay-midwife friend if he's let her know this! He doesn't seem to communicate very well and he may have forgotten to tell my midwife friend along with his nursing staff!

    I'm so sorry for all your wasted time! I know your midwife as a friend and through a volunteer organization we're both involved in and she's fabulous. I also have two friends whose births she attended earlier this year and one coming up in December so she comes to Ridgecrest a lot!

    Cheers!

  3. Thanks, Margo. I have a friend up in Whidby Island who had a similar deal. She did the first half of her prenatal care at the Naval Hospital then switched to the midwife. Thankfully, our much-begrudged DITY move left us with enough extra money that I'm able to just do midwife care. By the time Dr. Miller made the offer to do all my prenatal care, he had distanced himself so much from the kind of care I want that even if there ever was a chance of my considering it, I wouldn't choose him. I also felt like he offered that in an attempt to have more appointments where he could convince me to have a hospital birth.

    He definitely is not a good communicator, and I know the two midwives I know in the area had no idea he had changed his policy.

  4. I realize this was posted a year ago, but I'm currently 17 weeks pregnant with my first child and your story of talking to this OB parallels to my doctor visits. I would love more than anything to have a home birth, but it is close to impossible in my situation. My becoming pregnant was a (wonderful) accident, I wanted to wait until my husband and I are finished with school, with careers and living on our own rather than college students with part time jobs living with my in-laws before planning to have children. Anyways, I have had two visits to see my OB, and he and his nurse were nothing but condescending when I tried discuss having a natural hospital birth. Among other topics, I asked if it was necessary for me to have an IV during labor. They told me anything could happen and its best to be prepared for the worst. I cringed at this and asked since I was a low risk pregnancy, and requested not to be induced at all if I could opt out of the IV and be allowed to move as I please. They told me to research some more and come up with a more realistic birth plan, and that I should show proof that being induced leads to an unpleasant or problematic labor. I don't think I have to point out what was wrong with this statement…
    Your blog has inspired me to continue trying to find a better alternative for myself and my baby, and I thank you for that :]

  5. I'm so glad that my experience helped you! My sweet girl was born at home on March 27 and it was worth every hurdle I had to jump! I hope to have the birth story up soon. 🙂

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