How to Tell Your OB You're Switching to a Midwife
Switching care providers does not require your OB's permission. Schedule a final appointment, say directly that you have decided to continue care with a midwife, and request your complete records be sent to your new provider. Under the HIPAA right of access you can obtain copies of your own records within 30 days, and a practice cannot withhold them over an unpaid bill. ACOG's own guidance states that each woman has the right to make a medically informed decision about delivery.
Telling your OB you are switching to a midwife feels awkward because it reads as rejecting their care after they have invested time in you. Transfers between providers happen constantly in obstetrics, and the choice of where and with whom you give birth is yours. This article covers the words to use and the logistics behind them.
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Sources cited (3)
- U.S. Department of Health and Human Services, Individuals' Right under HIPAA to Access their Health Information (45 CFR 164.524)
- ACOG Committee Opinion No. 697, Planned Home Birth (April 2017)
- AAPC, From Antepartum to Postpartum: CPT OB Basics
What to say in the actual conversation
Keep it simple and direct: "I've decided to continue my prenatal care with a midwife and plan to have a home birth. I'd like to schedule a final appointment to go over my records and make sure the transition is smooth."
No explanation is owed, but if your OB asks why, stick to your own preference rather than criticizing hospital care: "I feel more comfortable with the midwifery model for a low-risk pregnancy" or "After researching my options, home birth is the right fit for our family."
If your OB tries to talk you out of it, you can say: "I appreciate your concern. I've done my research and found a qualified midwife. I'm here to make sure we transfer my care properly." Then redirect to logistics.
When to have this conversation
Tell your OB once you have hired a midwife and feel settled in the decision. Practices see transfers at many points in pregnancy, so there is no window you have missed.
Schedule a regular appointment rather than calling or emailing. That gives you time to ask questions and go through your chart together.
Do not simply stop showing up. A formal transfer of care belongs in your records, and an OB practice may be part of the picture again if complications develop later.
What records to request
Ask for your complete prenatal record, including lab results, ultrasound reports, and clinical notes. A midwife will want your blood type, antibody screen, glucose test, GBS status if tested, and any genetic screening results.
The HIPAA right of access, at 45 CFR 164.524, gives you the right to obtain copies of your own records from a covered provider. The practice has 30 days to respond, extendable once by a further 30 days, and it may charge only a reasonable cost-based fee. A provider cannot deny you access because you have an outstanding bill. If a front desk pushes back, that regulation is the thing to cite.
Most OB offices will send records directly to your midwife given a fax number or secure email address. Request a copy for yourself at the same time, in case anything goes missing in the handoff.
If you have had previous pregnancies, births, or gynecological procedures, request those records too. A prior operative report or a history of fibroids feeds directly into your midwife's risk assessment.
How most OBs actually respond
Many OBs are professionally courteous, transfer records promptly, and wish you well. They may disagree with the choice and still recognize it as yours.
Some express concern about safety and cite statistics on home birth risk. Listen, acknowledge the concern, and restate your decision. You can say: "I understand you see it differently. I've looked at the research and accepted the risk profile."
It is worth knowing what your OB's professional body says. ACOG's Committee Opinion 697 states that each woman has the right to make a medically informed decision about delivery. The same document sets out what ACOG considers the conditions for better home birth outcomes: appropriate selection of candidates, an attending midwife or physician practicing within an integrated and regulated health system, ready access to consultation, and safe and timely transport to a nearby hospital.
Some OBs react badly, decline further involvement, or make you feel judged. If that happens, collect your records and move on. Their agreement is not a requirement.
Whether your OB will still see you if complications arise
An OB is not obligated to provide backup care once you have transferred. Some will, especially after a long patient relationship. Others will not.
Ask your midwife how her own consultation and transfer arrangements work. Some practices have a named backup physician, some work through a collaborating practice, and some rely on the receiving hospital's on-call team. What is required varies by state, since collaboration and supervision rules differ, so ask what applies where you live rather than assuming a formal agreement exists.
If you transfer to a hospital during labor, you will most likely not see your former OB. Care goes to whoever is on call at the receiving hospital, or to your midwife's backup physician if that person has admitting privileges there.
What this means for insurance and billing
Tell your OB's billing office you are transferring care so they stop scheduling appointments and close out the pregnancy account.
Maternity care is normally billed as a global package covering prenatal care, delivery, and postpartum care under a single code. That package assumes one practice does all three. When care transfers before delivery, the OB bills the antepartum portion actually provided using antepartum-only codes instead of the global code: 59425 covers 4 to 6 visits and 59426 covers 7 or more, with individual visit codes used for 1 to 3 visits. Knowing those code numbers helps if a bill arrives showing the full global charge after a mid-pregnancy transfer.
If your insurer already paid a global fee, the billing office needs to rework the claim for the services actually delivered. That can take weeks and usually needs chasing. Keep your own record of what was paid and what you expect back.
▶ Ask your midwife Common questions to bring to your consultation
- Have you received all my records from my OB, including lab work and ultrasounds?
- Is anything missing from my chart that should be filled in before 36 weeks?
How to handle family or friends who know your OB
If a friend or family member referred you, they may feel caught in the middle. You can tell them: "Dr. X was great, and I'm grateful for the referral. I've decided home birth is right for me, and I'm continuing care with a midwife."
There is no obligation to discuss your reasons or justify the choice. Most people accept that birth preferences are personal.
If someone pushes back or takes it personally, set a boundary: "I appreciate that you care, and I've made the decision that's right for us. I'd love your support." Then change the subject.
Bottom line: Schedule an appointment, tell your OB directly that you are switching to a midwife, and request your records be transferred. Keep the conversation short and logistical. Permission and agreement are not required, and the HIPAA right of access covers getting your records regardless of how the conversation goes. What matters afterward is the paperwork: a clean transfer of care, a complete chart in your midwife's hands, and a billing account that reflects the visits you actually had.
- U.S. Department of Health and Human Services, Individuals' Right under HIPAA to Access their Health Information (45 CFR 164.524). The HIPAA right of access gives individuals the right to obtain copies of their protected health information within 30 days, extendable once by 30 days, for a reasonable cost-based fee. A provider may not deny access because the individual has not paid a bill for services.. View source
- ACOG Committee Opinion No. 697, Planned Home Birth (April 2017). ACOG states that each woman has the right to make a medically informed decision about delivery, and identifies appropriate candidate selection, an attending midwife or physician within an integrated and regulated health system, ready access to consultation, and safe and timely transport to a nearby hospital as factors associated with more favorable home birth outcomes.. View source
- AAPC, From Antepartum to Postpartum: CPT OB Basics. When maternity care transfers before delivery, the original provider bills antepartum-only codes rather than the global obstetric package: 59425 for 4 to 6 visits and 59426 for 7 or more visits, with individual evaluation and management codes for 1 to 3 visits.. View source
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Every guide on Home Birth Partners is researched against primary sources (federal regulations, peer-reviewed clinical literature, and state-level licensing boards) and reviewed by a credentialed midwife before publication.
We update articles when source data changes, when state laws are revised, or at minimum every 12 months. The "Last reviewed" date in the byline reflects the most recent review.
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