As promised, here is Collin’s letter to Dr. Miller. He’s much more subtle than I am.
I understand that you no longer act as a contingency physician for home births, as you have in the past. I have no qualms with your decision to provide care in the best manner you see fit; that is wholly within your purview and I commend you for your carefully considered philosophy of care. That being said, my wife clearly communicated to your staff that she intended to have a homebirth, and rather than inform her of your recent change in policy, they nevertheless scheduled an appointment with you, a needless appointment for which she waited one and a half hours. I hope that your staff was ill informed rather than deceptive by omission.
The decision to have a non-hospital birth is one that we have made with deliberate risk management, weighing with great gravity the risks and benefits of both hospital and non-hospital births. The extremely high rate of caesarian births at Ridgecrest – at 22% for a low-risk pregnancy, versus 10% for Bakersfield Memorial, per the Census Bureau – gave both of us pause. Hearing that Ridgecrest categorically does not conduct VBACs, contrary to the recently revised (August 2010) guidelines issued by the American College of Obstetricians and Gynecologists, makes me think that the OB/GYN standard of care in Ridgecrest is less than what it should be. If we lived in a city with a birthing center affiliated with a hospital, we would have preferred that, but given the option between a well-briefed home birth with a certified professional midwife versus a birth in a hospital in which one in five women with a normal, healthy pregnancy leave having had a c-section, I am compelled to think that the two options are at worst equal in terms of risk, to say nothing of other factors. I am supported in my opinion by the paper “Outcomes of planned home births with certified professional midwives” from the British Journal of Medicine, volume 330, which I commend to your reading.
Although she may not have presented her reasons for non-hospital births so succinctly, my wife nevertheless articulated her decision to have a home birth, a decision that you should have respected. Rather than politely informing her of your disinclination to provide care under the circumstances, you continued with what was in essence a sales pitch in an attempt to change her mind. Clearly, what transpired was a mutual waste of time, a waste that certainly could have been obviated by early, clear communication in what you do and do not provide and a respect for her articulated wishes.
Your comparison between appendicitis and pregnancy summarizes the gulf between our respective views of pregnancy and childbirth – pregnancy as a malady to be cured rather than a process to be observed and in most cases allowed to follow its natural course to fruition. I wish you well in your practice, and that you may better inform your staff of the care you have elected not to provide.