You need “shadow care?”

Many women who plan homebirths feel the need to consider the question, “Do I need ‘shadow care?'”  What exactly is shadow care, and when might you need it, want it, or not?

WHAT IS SHADOW CARE

I take shadow care to mean accepting obstetric oversight, planning to birth at home, but not telling the care provider about plans to birth at home.  I distinguish this from concurrent care which means that both woman and care provider are engaged in an open, consensual, and honest relationship.  For those of us who have planned homebirths while maintaining some sort of relationship to a medical care provider, the best situation is to have concurrent care.  However, it would be naive of me to suggest that all women will be able to enjoy this relationship.  Most OBs will not or cannot back up homebirth midwives.  So I recommend entering into this ‘care triangle’ very carefully and cautiously.

WHEN MIGHT YOU NEED SHADOW CARE

Here are a list of situations that have prompted women to seek shadow care:

• Desire for medicinal-grade pharmaceutical therapies/treatments for things like low progesterone, insulin-resistance, blood pressure issues, etc.
• Desire for viability ultrasounds in the 1st trimester; desire for the 20 week ultrasound; desire for a biophysical profile late in pregnancy
• Desire to be treated like human beings when hospital transfer is necessary during or after birth
• Desire for continuous care if/when transfer from homebirth care to hospital (obstetric) care becomes necessary
• Desire for a ‘contingency plan’ for if/when labor presents unexpected variables

WHEN YOU MIGHT REJECT SHADOW CARE (or someone who suggests it for you)

• If your midwife suggests shadow care, you must must must get to the bottom of this request
• If you suspect that your midwife is ‘using’ your shadow care as her backup care – that’s why midwives should carry insurance; if you can’t get to the bottom of this issue, find a different provider
• If you are experiencing unwanted or unnecessary pressure from friends, family, other care providers that are unsubstantiated

WHEN YOU MIDWIFE or DOCTOR ABANDONS YOU

• It is unethical for a care provider to abandon you for any reason in your final month of pregnancy – speak up!
• Investigate your options as thoroughly as possible in the time you have remaining in your pregnancy
• Distance yourself from the care provider (and his/her network) for the duration of your pregnancy & post-partum period – don’t invite them into that special time!
• Consider filing a complaint – to the hospital, to the local board of doctors, to the local board of midwives, whatever is most relevant
• Make sure other families in your sphere of influence know about your experience

I welcome your input on this post via comments.  Please understand that I am not a medical doctor or someone who is in a position to offer medical advice.  I’m offering advice as a mother who has had to deal the BS mentioned in this article or know other women who have been dealt with unethically as a ‘patient.’