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Homebirth – A GP’s View

head in sandI have a client who asked me to blog this for everyone’s information. She was horrified to receive this utterly unsolicited, unwanted and unnecessary letter in the post.

When she became pregnant she went off to get her routine bloods from a GP (this won’t be necessary if the maternity review grant provider numbers to midwives). It turns out she has a negative blood group. The GP obviously not informed on rhesus status or midwifery care wrote her a letter.

I note that you decided against first trimester screening because of concerns about radiation doses and are planning a homebirth with an independent midwife. I respect your right to make a decision about your antenatal care and birth plan but it is important that these decisions are informed.

Subtext.- I respect your right to listen to what I have to say and then totally agree with me and take up the care option that I think is the best.

My major concerns are(1)your rh negative status and it’s implications for you during this pregnancy: for your baby during this current pregnancy : and for any subsequent pregnancies:(2)a planed out of hospital birth. I would remind you that I do not offer shared obstetric care and refer all pregnant women for specialist care. There may be other investigations or procedures recommended during pregnancy about which you are entitled to be informed.

subtext.- you are rhesus negative and I know absolutely nothing about it so I will scare the pants off you so you will get another doctors opinion. Also you turned down some screening and your midwife is ok with this so she won’t force you into any other test that you should have. Only a Doctor is trained to do that.

It is recommended that rhesus negative women receive anti D at 28 and 34 weeks gestation and have their antibodies recheked. It is also important to know the baby’s rhesus status at birth. I strongly recommend that you consult with an Obstetrician now to discuss this and to be reviewed so that you can be reassured as to your own and your baby’s well being. rhesus negative women also require review if they have vaginal bleeding during pregnancy as treatment may be required.

subtext.- I really have no idea that an Ob doesn’t deal with your rhesus status a midwife does. I do not understand that an independent practitioner keeps on top of my rhesus antibodies and offers anti D in the event of an antenatal incident. I have absolutely no clue that the local hospital test the blood brought in by midwives if the woman is rhesus negative to check the baby’s blood group. I didn’t bother to find out that anti D is freely available to you if you have a positive baby.

Meeting with an Obstetrician will also enable you to be informed about the risks of a planned out of hospital birth. May be that the midwife led antenatal programme at the WCH may represent an acceptable compromise for you. Suitable pregnant women looked after by a midwife throughout their pregnancy and delivery. Delivery is at the hospital in a home like environment. The important difference is that the state of the art monitoring and specialist staff is on hand should they become necessary.

subtext.- Every woman should have a surgeon. You really should birth at the hospital because we (the medical facilty) think that’s best. State of the art monitoring is very impressive to me and I have no idea what happens at a homebirth.

I genuinely respect your right to make decisions regarding your care during pregnancy and childbirth. I cannot support your decision to pursue a home birth. My intention in writing is to advise you to meet with an obstetrician and make yourself fully informed as to the relative merits and consequences of the various options available to you. Once fully informed you can feel conformable that you have made the best and safest decision for you and baby and then relax and enjoy the rest of your pregnancy.

subtext:- Once you have decided to go to the hospital all will be well. An informed choice is really doing as we say.

incompetenceThanks Dr Cathy Dillon for providing us with confirmation that many GP’s in Australia are truly uninformed in maternity services.

That’s why when it comes to pregnancy and birth General Practitioners are not required. Midwives are specialist in normal and Obstetricians are specialists in complications.

Makes you wonder if the serious lobbying going on by the AMA is making the medical fraternity a little nervous.

9 responses to “Homebirth – A GP’s View”

  1. Kristin

    Excellent – I was looking for a new GP so there’s one I can cross off the list!

  2. slh35661

    Wow. I can’t believe anyone would send this out. This really constitutes a threat in my book. As a midwife in the U.S. I would never ever put something like this drivel out, and I would be shocked if I found out any of my physician collegues had done so either. This actually reads like someone bought a pamphlet somewhere with a prepackaged saying on there and is sending it out to patients for the sole purpose of directing them against midwives. Be very weary. This is how they almost killed the practice of midwifery once in the U.S.

  3. Riss

    If it wasn’t so condescending to all women it would be bloody hilarious! How wonderful that we have such fabulous doctors to look after our best interests (insert sarcasm).
    This is not the first time I’ve heard such a story and I’m sure it won’t be the last.
    I’m still shaking my head.
    Larissa xx
    Independent Midwife and proud homebirther!

  4. Anonymous

    It would be all well and good for GPs to refer pregnant women to Obstetricians so that they could “be informed”, if only the average Obstetrician had the slightest clue about a normal pregnancy (and shockingly, I include Rh negative women in that list!).

    Moospie

  5. SacredAngel

    I don’t know about in Australia but in the US, GP stands for general practitioner which equates to at least 6 years of school. I can’t believe that she would send that out speaking as a professional. The grammar in that is HORRIBLE. Made my eyes bleed.

  6. maria

    Ugh, says the homebirthing Rh-negative woman.

  7. Kel

    rhesus negative homebithing mother of 3, 9 and half pounds, 10 pounds and 11 pounds and 1 shoulder dystocia. that doc would have run screaming!

  8. ries

    hello lovely Lisa!
    you will remember my own saga this year with the very same comments made, every time (repeatedly) when i attended the physician/endocrinologist this last pregnancy. the fact I was having my fifth, was 40 years old, with diabetes and thyroid disease, planning a (potentially breech, persistant until 37 weeks) home birth, obviously PROVED that I could not be well informed, and that my midwife was completely irresponsible. (every one wanted your name Lisa!) i relished every opportunity to put him and her and her (all three) in their places (which was as my employee!), with the aim of informing them that home birth is not a risk for those that plan. my argument for the question of the unexpected was, ‘how long does it take a private ob to get into a ready theatre?’ answer… a lot more time than transporting to hospital from my house with a ringing ahead midwife! their inherrant belief also seemed to be that they had a duty of care to let me know their opinion of my choice, rather than adress why I attended at all (blood tests actually). in the end it was funny. they would ask… well what if you…. this or that to which I had my prepared birth plan answers, until finally in exasperation the last one ended, “well… women as old as you, after 4 babies nearly always have their uterus turn inside out after delivery… what will you do if that happens at home!” ( I replied, ‘shove it back in and head to hospital, I’m not planning any more kids so a hysterectomy’s no problem really”. she gave up after that….)”YOU have a much bigger risk of bleeding to death from a car accident tonight than I do from this pregnancy”, is what i would have liked to say, but i was not sure of the real road stats, and did not want to look mean!
    What surprises me most is the genuine shock of previous bloggers….this is just the first written case i have heard of… but my dr emailed me her concerns also, repeatedly until she heard baby born, then declared me one of the ‘Lucky’ ones…after all went so well… sorry I deleted them now! also she rang my previous attending ob to arrange MY follow up with him IN CASE of her absence, without my permission, passing on details of my subsequent care (since i had left him, this was highly offensive!!!!)
    sigh…. fight on girls… there is a long way to go!
    and each one of you a tremendous support to true INFORMED choice…

  9. Anonymous

    Doctors always “respect your right to make decisions regarding your care” – as long as you “decide” to do what they tell you to…