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Can you be *made* to see an OB?


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#1 Neriah

Posted 23 June 2011 - 09:43 PM

Hi,

I was just wondering if there are any situations where you *have* to see an OB (whether going private or public). When the time does come I would prefer midwife led care but I have a few health conditions. I don't think they would affect a pregnancy so much as myself in general. I have:

- moderately low blood pressure (and I can't take either medication for it due to cushing's for one, and allergies for the other)
- I'm post-cushing's and therefore have some bone, muscle, and skin damage
- hypermobile joint syndrome (high chance of SPD, I dislocate easily, have a few positional restrictions etc.)
- high tolerance to pain killers and anaesthesia (due to cushing's)

Is it likely that I would be placed under the care of an OB? I really want a non-interventionist approach and I can imagine a lot of restrictions being enforced to be 'on the safe side.' I have no problems seeing a doctor but I don't want an OB as a primary caregiver if that makes sense. And it is particularly rare to find a GP who has any experience with cushing's let alone an OB. I've only recently moved and don't have a regular doctor yet who I can ask about this. While I may be getting ahead of myself I am a planner and that's just what I do. Any advice?

TIA.

Neriah original.gif

ETA: Not pregnant, just planning. I also want to know so I can make decisions about whether or not to invest in private health insurance given the waiting periods etc.

Edited by Neriah, 23 June 2011 - 09:52 PM.


#2 Eloueraview

Posted 23 June 2011 - 09:49 PM

Good luck original.gif

I wen with the shared care model..  and found it great that my OB (also my GP) would check over everything and make sure the pregnancy was tracking..  and the majority of the visits were with my midwives.

Come the time for the birth.. i had the doctor visit, everything was progressing well..  and i ended up delivering with my husband, and my midwives only..

I dont think you can be "made" as such, but i think it IS a good idea.. as you honestly dont know what birth and labour are going to bring.   Id be wanting to establish a relationship with the OB, so that you can express your views.. and see how they respond to them.

Good luck again!

#3 Melissam12

Posted 23 June 2011 - 09:51 PM

Yo can choose midwifery-led care but this will be more likely if you have a private midwife as hospital midwives must refer you to obstetric-led care if needed, whereas a private midwife would always remain your care provider.

#4 jorgo

Posted 23 June 2011 - 09:55 PM

a fertility specialist who is also an OB would know about the cushings


may be your best bet

#5 tygrays

Posted 23 June 2011 - 09:58 PM

if you're not looking at a homebirth in which case you can hire an independent midwife who will do all your ante and post natal care you can still hire a private midwife or doula who can be with you at any appointments like this who can help voice your desires.  They will also support you through labour and ensure that your desires are always honoured.  

You can not be "forced" into accepting any particular level of care or be "forced" to see a particular health care professional, however you may come across threats and bullying if you don't mould to what is perceived to be the accepted model of care.  Just remember what ever way you do go that YOU are the person employing the people whom you are seeing, YOU pay their bills, YOU can hire and fire as you need to in your search to find the correct health professional for you, and you can make these changes at ANY TIME throughout your pregnancy!!!

Good luck with your search and falling pregnant original.gif  It's a wonderful journey to be on original.gif

#6 Neriah

Posted 23 June 2011 - 10:44 PM

Thanks for the replies. I'm honestly suprised at how much my views have changed about pregnancy and birth in the few months I've been looking into it. So much isn't talked about amoung family or friends so I'm glad I've been doing my research. I've gone from being very medical to non-interventionist, however, given my medical history I do think I should be in a hospital (it is also something that is not up for discussion with dp). Apparently, the hypermobility can also lead to premature delivery (I was 8 weeks premmie myself), so I don't think I would make a good candidate for a home birth. I have no idea how I will be on the day so that's another reason why I want to be at a hospital, but I do not like the way OB's and hospital's view birth. I actually had this dream where I was in hospital in labour in the corner of the delivery room using an IV pole to keep the doctors away! Lol. I guess that if I'm going to need obstetric care then I will probably need private health insurance so I can choose the right person, however, I am worried that that step will mean it will be less likely that I would achieve a natural birth (also PHI is expensive!). I would definitely use a doula or independent midwife regardless. Ahh, decisions!!!

#7 SeaPrincess

Posted 23 June 2011 - 10:54 PM

You could look for a maternity hospital with a birthing centre on the premises.  The birthing centres are midwife-run but full medical facilities/OBs are available as well.

QUOTE
I do not like the way OB's and hospital's view birth


I recommend you have a look around at more OBs as well. I had my babies in 2 hospitals in 2 states, both with OBs and hospitals which were fully supportive of natural birth.  My OB in Perth was pro-VBAC and also delivered my friend's twins naturally.

R

#8 EthanEmmaLola

Posted 24 June 2011 - 10:19 AM

At the hospital I am booked in at we have the option of Midwifery group practice (see the same midwife the whole way through), midwifery clinic (just see whatever midwife is on) and Shared care (between gp and midwife)

I am with MGP, I have one midwife I see for each visit. If I needed to be referred to an OB at the hospital I would still have my midwife but just have appointments with both people (I was actually referred at my first appointment but when I went the OB didnt know why and my midwife said I didnt have to go back)

If there is something like MGP available where you are I would go with that original.giforiginal.gif

#9 seepi

Posted 24 June 2011 - 10:34 AM

With a lot of medical issues aside from pregnancy, my feeling is that you would be sent to an OB.

I would recommend a doula, to assist in the birth and keep things as natural as possible if that is what you want.

But don't panic too much about OBs. I've had 3 private births with OB and no drugs or intervention. None were offered to me at any stage - keep in mind that many of the caesars done by OBs are wanted by the women.

#10 karablue

Posted 24 June 2011 - 02:50 PM

As some other PPs have said, if it is an option 'shop' around for OBs. My OB is wonderful and the thought of cesars as a routine option horrifies him.  To him they are only for emergencies.  He totally supports drug-free birth.  In fact he tells me that birth should be done wherever possible as God intended - natural and drug free.

Interestingly for me with my previous pregnancies, it was the midwives that tended to force the having drugs or gas issue and we like you to deliver on the bed, etc.

So midwives are not necessarily always the better option.  It is good you are starting early and good luck with finding what you are looking for.

#11 city*reader

Posted 24 June 2011 - 03:39 PM

Obstetricians aren't inevitably anti-natural birth, and if you do have complex medical needs other than pregnancy related or that can complicate pregnancy they can be the best option.  One of my most fondly remembered caregivers was (is) a male obstetrician, one who is very very very pro-natural birth, even pro home birth.  Don't judge the caregiver on qualification alone original.gif

#12 Soontobegran

Posted 24 June 2011 - 07:19 PM

QUOTE (Neriah @ 23/06/2011, 10:44 PM) <{POST_SNAPBACK}>
I do not like the way OB's and hospital's view birth.


Oh?

The different views amongst hospitals and obstetricians are as varied as those amongst private midwives.

There are many hospitals which have midwifery led care and you will not be forced into seeing an obstetrician unless there is a medical problem that necessitates it, but that would also happen even if you saw a private midwife.

If you are not considering a Homebirth then you need to find out if the hospital you book into will allow your private midwife to be anything other than a support person at your delivery as many will not let them make any medical decisions for you.

Just for the record there are many,many obstetricians who are supportive of natural childbirth, it might pay to ask around your area and get some recommendations.

Good luck for your pregnancy.

#13 StopTheGoats

Posted 24 June 2011 - 07:39 PM

.

Edited by OldMajor, 04 July 2011 - 11:39 AM.


#14 katiebelle

Posted 24 June 2011 - 10:50 PM

I agree with the PP's, just because you have an OB or a private hospital does not mean an automatic c-section. I have had 2 drug free natural births under an OB and am about a month away from my 3rd. Never was it suggested that I required a c-section or drugs or any such thing.

I think c-section rates for some private OB's can be really blown out by patient request, I know a woman who had a c-section for her 1st baby to get the birth date she wanted as it was a December baby so she wanted to pick the date to be away from Christmas etc, obviously she found an OB willing to do this.

Good luck with your research and in falling pregnant original.gif


#15 Neriah

Posted 25 June 2011 - 03:09 PM

QUOTE (soontobegran @ 24/06/2011, 07:19 PM) <{POST_SNAPBACK}>
Just for the record there are many,many obstetricians who are supportive of natural childbirth, it might pay to ask around your area and get some recommendations.


Of course. I did not mean to make a sweeping generalisation. I have had a lot of bad experiences with doctors throughout the course of my illness and was training to be a midwife when I became ill and could no longer complete it. So, for those reasons I am a little biased. There is good and bad everywhere, and I have heard some wonderful OB stories and some shocking midwife stories. Though my reluctance is obvious, I am not against seeing an OB, I was more curious if I would be prevented from having midwife led care and 'forced' to see an OB only. I live in Launceston, so there aren't many options to begin with. I'm mostly considering this now in order to determine whether or not I should get private health insurance. I went to get it when I got sick at 18 and was told that I could never claim for the complications caused by my cushing's cause I already had it - therefore, it was classed as a pre-existing condition. I would probably prefer to go public to avoid all of the issues with PHI and to be in a place with emergency equipment, but as I expect I will have some problems due to my medical history, I want to make sure that I have set myself up for the best experience possible. Pregnancy is something that is terribly hard to predict. Thank you all for the advice. I appreciate it.

Neriah original.gif

#16 peppersmum

Posted 25 June 2011 - 03:30 PM

QUOTE (tygrays @ 23/06/2011, 09:58 PM) <{POST_SNAPBACK}>
if you're not looking at a homebirth in which case you can hire an independent midwife who will do all your ante and post natal care you can still hire a private midwife or doula who can be with you at any appointments like this who can help voice your desires.  They will also support you through labour and ensure that your desires are always honoured.  

You can not be "forced" into accepting any particular level of care or be "forced" to see a particular health care professional, however you may come across threats and bullying if you don't mould to what is perceived to be the accepted model of care.  Just remember what ever way you do go that YOU are the person employing the people whom you are seeing, YOU pay their bills, YOU can hire and fire as you need to in your search to find the correct health professional for you, and you can make these changes at ANY TIME throughout your pregnancy!!!

Good luck with your search and falling pregnant original.gif  It's a wonderful journey to be on original.gif


Yes good information!

OP I chose to avoid a OB by employing private midwives for my 3rd and 4th births/  I probably would have been able to avoid it if I still birthed in hospital for my 3rd but chose a home birth instead.  For my 4th I would have been labelled 'high risk' as I had a PPH (post partum hemorrhage) in my 2nd and 3rd births and the 3rd birth was over 1 litre which is a risk factor within all guidelines (midwives and OB's).  I did NOT want to see an OB or birth in hospital so I chose a private midwife who agreed to support me.  All she did was to advise me of the 'risks' and then that the normal procedure would be to birth in hospital, I then declined and she put it in my notes and that was the end of the story (which is what is stated in the midwives guidelines).  We then planned for a home birth and worked hard on reducing my chances naturally of another PPH - it all paid off and I birthed my 4th baby 4 weeks ago with only a loss of 550 mls and I felt wonderful!!!  No transfer to hospital like I had in my 3rd birth after my PPH and no visit with any OB's the entire time  wink.gif

So yes it IS possible NOT to see an OB if you don't want to even if you are classed as 'high risk', it just depends on what the risk factors are and if the midwife you choose is happy to support you!



#17 Swan Lake

Posted 25 June 2011 - 03:56 PM

I was transferred to the high risk client at my public hospital and saw obs for all my antenatal visits. However, at the birth, I had my midwife for the labour and a couple of neonatal specialists at the moment of delivery to check the baby. I got to choose the level of intervention I was comfortable with the whole time and had a natural delivery. Seeing obs during your pregnancy doesn't necessarily lead to intervention or c-sections. original.gif

#18 robhat

Posted 25 June 2011 - 04:01 PM

I don't actually know, but I would assume that if you became high risk enough and were going through a birthing centre or similar that you may end up having to see an Ob and the midwives would probably have to refer you for various reasons to do with insurance and being sued etc. You may get some caregivers refusing to support your choices if they feel the risk to their 'careers' is too great, if that makes sense.

I'd actually suggest that if you want to maintain control over who your carer is and your options for childbirth that maybe it would be better if you did the research now and find an Ob that suits you. If you ended up referred to one, you may not have much choice and may get an Ob that is totally different to what you would like. Sure you can refuse to go along with his/her recommendations, but you'll still be left with the stressful situation etc and may not be able to find care givers who suit you when the need arises. I think given that you have medical conditions which may make it more likely that you'll need the services of an Ob, you'd be better of being pro-active and choosing an Ob that will help you (to the best of their ability) to get the birth you want.

And I think it is possible to go private in a public hospital with the Ob of your choice if that suits you better. You could also have your own midwife or doula as well as the Ob. I think actually it would be better for you to start looking quite specifically at the hospitals and various caregivers, including Obs that are available in your area to see what choices you have first. Obviously if you find that all the Obs near you are high interventionists then you won't want to go that route...

#19 tygrays

Posted 25 June 2011 - 04:40 PM

Hi again OP,

Seeing that you're in Launceston you'll find that you may not have that great a choice regarding hospitals, obs and antenatal care.  Definitely start your research NOW!  Another thing to consider is the longevity of the health professionals and how far away you are considering felling pregnant.  When we were in Tas (moved just over a year ago) the obs and staff didn't hang around that long, in fact we had 3 babies under 3 years and each had a different ob as they simply didn't stay long enough - whether that has changed is something you will need to look into etc.

I believe Launceston has a birth centre now - that could be an option for you.  Make sure when researching that you ask what their hospital policy is regarding your specific situation and what they will require.  I suggest that as I have recently seen a midwife for my own care (another state and hospital obviously) and although the midwife agreed that what I was asking and requesting for my situation was best for me that it was something that would not be possible in the hospital as it was against their policies - just something to think about!!!

There are some independent midwives in the Launceston area who will work inside as well as outside of the hospital system.  

So you may be able to get the birth you want and be able to avoid the intervention, but I do strongly recommend you start researching now and work out if the IM, public or private system would suit you better.  Maybe post about the options and experiences other members have had in the Tassie forum?  

BTW - if I could I'd be back in Tassie in a flash to birth our bubs!!! At least there I could write a birth plan and know I had the ability to say "no" to things and it would be honoured!!!

#20 Expelliarmus

Posted 25 June 2011 - 04:48 PM

Yes, if you have Gestational Diabetes you do have to have an OB.

I mean, I assume you could refuse to see one if you chose but once you have that diagnosis then care is shunted to the OB as you have to be monitored differently and a hospital won't continue your antenatal care without seeing the OB. However as I understand it, as a public patient this means a minimum of 2 OB visits - this was the case with my niece - and not necessarily a raft of interventions. If your GDM is straightforward then all that will happen is that you have a different battle to fight regarding the treatment of the diabetes. A lot of places are conservative about it.

Despite going to the OB from the get go, knowing I would have to have one by the end of it all, I did not have the OB at either birth where I had diagnosed GDM. The midwives still manage the majority of the birth - I merely needed the OB for the medical side of my pregnancy. Because I was under one they did attend the birth - but not until it was over biggrin.gif

#21 Not Escapin Xmas

Posted 25 June 2011 - 05:11 PM

I had a private OB and went to a public hospital. He's very pro natural birth and non-intervention. The labour ward in the hospital that I went to had a huge bath and shower for each woman, fit balls, bean bags, mats etc etc. We had one midwife for nearly the whole labour. So, even though all the 'medical' stuff was there if/when we needed it, it wasn't obtrusive and wasn't forced on us. Good luck with your decisions!




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