You don't need your OB's permission to switch care providers. Schedule a final appointment, tell them directly that you've decided to continue care with a midwife, and request your complete medical records be sent to your new provider. Most OBs are professional about transfers, even if they don't personally recommend home birth.
Telling your OB you're switching to a midwife feels awkward because you're rejecting their care model after they've invested time in you. But transferring care between providers happens constantly in obstetrics, and you're entitled to choose where and with whom you give birth. This article gives you the exact words to use and the logistics you need to handle.
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."
You don't owe an explanation, but if your OB asks why, stick to your 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.
Tell your OB as soon as you've hired a midwife and feel confident in your decision. Most people switch between 20 and 32 weeks, though some transfer earlier or later.
Schedule a regular appointment rather than calling or emailing. This shows respect for the relationship and gives you time to ask questions and review your chart together.
Don't ghost your OB by simply not showing up for appointments. You need a formal transfer of care documented in your records, and you may need their backup support if complications arise later.
Ask for your complete prenatal record, including all lab results, ultrasound reports, and clinical notes. Your midwife needs your blood type, antibody screen, glucose test, GBS status (if tested), and any genetic screening results.
Most OB offices will send records directly to your midwife if you provide the fax number or email. You should also request a copy for yourself in case anything gets lost in the transfer.
If you've had previous pregnancies, births, or gynecological procedures, request those records too. Your first birth's operative report or your history of fibroids matters to your midwife's risk assessment.
Many OBs are professionally courteous, transfer your records promptly, and wish you well. They may not agree with your choice, but they recognize it's yours to make.
Some OBs express concern about safety and may cite statistics about home birth risk. Listen respectfully, acknowledge their 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."
A small number of OBs react negatively, refuse to continue backup care, or make you feel judged. This is unprofessional but happens. If your OB responds this way, get your records and leave. You don't need their approval.
Your OB is not obligated to provide backup care once you've transferred. Some will, especially if you've been a patient for years. Others will not.
Your midwife should have a formal backup physician relationship already in place. This backup doctor has agreed to accept transfers from that midwife's clients and is usually someone who respects the midwifery model.
If you need hospital care during labor, you won't see your former OB. You'll see whoever is on call at the hospital where you transfer, or the midwife's backup physician if they have admitting privileges.
Tell your OB's billing office that you're transferring care. They should stop scheduling future appointments and close out your account for this pregnancy.
You'll be billed for all services provided up to the transfer date. Many OB practices use global billing, where they charge one fee for all prenatal care and the birth. If you transfer mid-pregnancy, they should bill only for visits completed, not the full global fee.
If your insurance has paid the OB's global fee upfront, the billing office needs to refund the portion covering services you didn't receive. This can take weeks and requires follow-up. Keep records of what was paid and what you're owed back.
If you were referred by a friend or family member, they may feel caught in the middle when you switch. 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."
You don't need to discuss your reasons or justify your choice. Most people understand 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.
Schedule an appointment, tell your OB directly that you're switching to a midwife, and request your records be transferred. Keep the conversation brief and logistical. You don't need permission, approval, or agreement. You need your paperwork and a clean transfer of care so your midwife has everything she needs to support you safely.