OB-GYN-L Messages for November, 2005: Re: OB: Home births

Re: OB: Home births

From: D. Ashley Hill

dahmd@cfl.rr.com

Tue Nov 15 12:10:53 2005

1. Concern that home delivery is not optimal for many patients.

2. Concern over legal liability. Intuitively, one would think a patient who chooses to deliver at home then comes to the hospital is "on her own" legally, but that's not the case. As amazing as it sounds, our legal system may allow the OB on call to be liable for events that occurred at home. I have seen lawsuits over eclamptic seizures at home with subsequent hospitalization, where the "lay midwife" without insurance was left free of liability but the on-call OB got hit with a large lawsuit.

3. Concern that in many areas the majority of reimbursement for OB care is for the delivery process, not the prenatal care. It can be challenging to obtain reimbursement for prenatal care alone for non-Medicaid patients.

4. Most importantly (IMO), the dishonestly inherent in this situation. Patients all want Marcus Welby to care for them, but patients willing to lie to their physician throughout pregnancy have violated the mutual trust and respect physicians and patients should have for each other. Most ob/gyns chose this field because they really like their patients and the patient/physician partnership. I could not continue to provide care for someone who has abandoned this relationship to the degree necessary to lie throughout pregnancy.

Thanks,

Ashley

At Tue, 15 Nov 2005, Jamie wrote: >
>This sounds like a very reasonable, proactive solution. One of the
>major reasons, from my conversations with other homebirthers, to have
>prenatal care with a physician is in order to avoid drop-in status if a
>transfer becomes necessary. Another is to have labs done if the midwife
>isn't able to do them-depends on the state. Concurrent care, of course,
>should be open on both sides. If you aren't willing to participate in
>concurrent care, is there a local practice that is comfortable with it
>to whome you could refer these patients? Something to consider is that
>many people probably don't understand that this costs your practice
>money. Providing that information may help decrease the numbers-it's
>not something I would have realized at the time of my first home birth.
>I didn't have concurrent care b/c I was okay with the on-call doctor if
>I needed a transfer and b/c my midwife was able to do the necessary
>prenatal labs in that state.
>
>At Tue, 15 Nov 2005, Marie Harkins wrote:
>>
>>Garry,
>>
>> Your practice is being put in an awful position. I think that it is
>>entirely appropriate to discharge these women from your care. It
>>could be stated in an introductory letter that you value an open and
>>honest relationship with your patients. If this trust is violated by
>>someone using your group for prenatal care but planning a homebirth,
>>care from your practice will be terminated. This would bring up this
>>issue at the 1st visit and focus on your requirement of an honest
>>patient/provider relationship vs condemnation of home birth. It is
>>also an issue that your CNMs could directly discuss with the woman at
>>the first visit.
>>
>> If these women need to be transported from home, is your practice then
>>responsible for providing the hospital care because they have been
>>established with you during the pregnancy? It is probably not legal
>>or ethical to have them enter the "county call" system since they have
>>seen you for care. If it were possible, that would be another
>>deterrent to them seeking your practice out.
>>
>>--
>>Marie Harkins, CNM
>>Ithaca, NY
>>
>--
>JFields, RN, BSN
>

-- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency and Loch Haven Ob/Gyn Group Orlando, Florida

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