The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Letter to Doctors Requesting Backup

I don't mind sharing the letter - especially since it worked for me. Please feel free to revise it to fit your circumstances (using different options, etc.) We had the letter personalized for each doc, and as I mention at the end, I also sent copies to the two hospital administrators, allowing them to see that I am really working to get cooperation from the docs. My plan was to follow through with a second letter in a couple of weeks if I hadn't heard from the docs - saying something like "I haven't heard from you. Am again hoping to find out your wishes so that any referrals/transfers can be made according to your preferences if you are on-call. If I don't hear from you, I will assume that you have no particular preferences in this matter and I will proceed according to my own best judgment" (obviously in dressed-up rhetoric). A copy of that letter, too, would go to the administrators. The hope was that if the docs didn't respond and got upset about a transfer, I would have left lots of tracks demonstrating to both the physicians and the hospitals that I had tried repetitively to find out how they wanted me to proceed. The assumption here is that I will do homebirths and they can't do anything about it, and that I will inevitably need the services of an OB and a hospital at some point (unless I am incredibly lucky). It is not a request, nor pleading for their support (I have a client who will kill me if I sound like I'm pleading with the docs). Hopefully, it sound assertive and matter-of-fact, non-hostile, and appropriate to respond to. Thanks to all for your congrats. I still feel really good about it!

Dear Physician

My client load for is growing and I have due dates approaching this Spring. Now is the time to find out how you wish to work consultation/referral/transfer arrangements. Undoubtedly I will have clients in need of a specialist for one reason or another. My intent is to have them access the physician and hospital of their choice when the need arises. Because you may have individual preferences for how such referrals work, I'm asking each Obstetrician in the area what those preferences are so that my clients can be worked into the system as smoothly as possible. I would appreciate your response to the following:

If a client develops a pregnancy complication and chooses you for consultation or referral, how do you want us to proceed?

____ Have me or the client call and schedule an appointment with your
receptionist.
____ Send you a letter detailing the client's history and problem, with
chart copy.
____ Have me call and speak with you personally before making an appointment.

____ Take the client to the ER without notifying you first; have the ER
doctor call you.
____ Call OB first and have the nurses phone to tell you the client is
coming in.
____ Call you first to discuss the problem and arrange transfer.

My desire in these matters is to cooperate with you as much as possible and respect your individual preferences. I do not consider it responsible care to dump complicated clients on you without warning or taking responsibility. So, please return this form to me in the enclosed envelope. If I don't hear from you I will assume you are comfortable with my judgment in these matters. If you prefer to talk with me in person please check below.

        ____ Please schedule an appointment to talk with me in person about this.

Cc: Hospital Administrator (for these folks, I enclosed another letter explaining again that I was seeking to cooperate with the medical system rather than working in opposition to it, and thanked them for their support of my practice (which is allowing me to order sonos, labs, and providing my birth meds through their pharmacy)).