Although rare, some midwives have doctors who back up their care and offer to deliver the midwife's client if she has to be taken to the hospital. This is also known as a back-up doctor. In this situation the midwife and doctor have met and agreed upon protocol for the doctor to see the midwife's clients, which includes the doctor's participation in her care. The protocol will differ with each midwife/doctor relationship, but will usually require that the doctor see the midwife's client at least a few times during her pregnancy.

If a woman has a Certified Nurse Midwife (CNM) to attend her homebirth, her midwife is required by state law to have a back-up doctor. This creates a delicate situation if the client wants to avoid the doctor's office completely. The back-up doctor will require her to see him/her several times throughout the pregnancy. Furthermore, in this case, the midwife is fortunate to have found a doctor who made it possible for her to legally practice; she has developed protocol with that doctor and must abide by it. However, the client should talk with her CNM about if and how she might satisfy the midwife/doctor protocol and still stay true to her own wishes for her pregnancy.

Because of the legal statues of non-CNM midwives, most will not require that their clients have a back-up doctor, however, some may require a back-up doctor for women having their first baby.

Most doctors are not supportive of homebirth. And this unfortunately creates a difficult situation with few options for the woman who finds herself in a position where she does not want a back-up doctor, but her midwife requires it, or she does want a back-up doctor in case of a possible hospital birth.

The first option is to "Take Your Chances."
This option is for the client that has a non-CNM midwife or for the client who wants to avoid the doctor's office as much as possible. It means that she does not see a doctor during her pregnancy and if she is transported to the hospital she takes the doctor that is working that shift. However, as much as she might want to avoid the doctor's office, her midwife will probably require initial lab tests (complete blood count, antibody screen, maternal blood type, syphilis, Hepatitis B, HIV, and a urinalysis) and PAP smear. This option requires her to find a doctor for those. It is best that she not mention that she is planning to have a homebirth, unless she knows that the doctor is supportive of this, so the visit may be a little scary. However, there are many women who will give birth in a hospital who never or rarely go to their prenatal visits, so she should keep this in mind. If she is asked to schedule another prenatal exam she can just tell the receptionist that she forgot her date book and will have to get back to them.

The second option is to "Play Along"
This option is for the client who wants to secure a doctor to deliver her baby if she ends up at the hospital. It means that she will go to a doctor for routine prenatal exams in addition to her midwife's exams. If the birth happens at home she will simply say that the baby came so quickly that she could not make it to the hospital in time. If there is a complication and she has to go to the hospital for the birth, the doctor should come to deliver the baby. This option ultimately means that she must deceive her doctor. And, if she lacks medical insurance, must pay for the doctor's services out of pocket.

No matter the situation, the client should discuss her options of a back-up doctor with her midwife, who may have other suggestions not mentioned here.