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Homebirth moms - need your advice


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  #1  
February 17th, 2010, 08:22 AM
~ Christine ~'s Avatar Platinum Supermommy
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Location: Dallas, TX
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so, my only option other than the hospital would be a homebirth, which I'm considering. I'm arming myself with info right now to talk to DH today. I was just talking to my mom about it and she loves the idea, but her one question was - on the very minimal chance that something happened, how would you react?

I KNOW the chances are small, and probably about the same as in the hospital, but if something were to happen, would you always wonder what the outcome would have been if you hadn't given birth at home? How do you prepare for / wrap your mind around that possibility?
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  #2  
February 17th, 2010, 09:26 AM
Aeterna's Avatar Super Speshil
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By "something happened" is that referring to a birth complication or stillbirth/neonatal loss? I think my reaction would depend on what took place.

Quote:
How do you prepare for / wrap your mind around that possibility?

I'll share a post I made on another form about the 'what if' argument/possibility and how to be prepared or what to look out for.

Quote:
I see this a lot. I understand it. Education can help ease worries and know what goes into the training of midwives. There's a mom I know that would have others write down their exact fears concerning labor/birth. Hospitals provide a false sense of security and aren't safer than OOHB. Current research and studies have demonstrated this over and over.

Here's an excerpt from the article I shared:

Quote:
[. . .]

The third false assumption is there can be faster action in the hospital. The truth is that in private care the woman's doctor often is not even in the hospital most of the time during her labour and must be called in by the nurse when trouble develops. The doctor 'transport time' is as much as the 'transport time' of a woman having a birth center or home birth. Even when a caesarian section is indicated, it takes on average 20 minutes for the hospital to set up for surgery, locate the anesthesiologist, etc. and during this 20 minutes either the doctor or the birth center or home birthing woman are in transit to the hospital. This is why it is important for a good collaborative relationship between the out-of-hospital midwife and the hospital so when the midwife calls the hospital to inform them of the transport, the hospital will waste no time in making arrangements for the incoming birthing woman. These are the reasons there are no data whatsoever to support the single case, anecdotal 'what if' scenario used by some doctors to scare the public and politicians about out-of-hospital birth.

[. . .]
Source

Assuming one lives in close proximity to the hospital then situations that require transfer or immediate attention would be the same in a hospital setting. By the time you get to the hospital the OR will be ready. This is assuming it's an emergency situation.

The most common complication in labor is nonreassuring fetal heart tones. This isn't something that arises suddenly or out of the blue where the baby will die within five minutes. It's something noticed over a period of time. If the heart tones don't recover or stay low too long over a certain period of time then it warrants immediate attention/intervention.

While on the topic of nonreassuring heart tones we'd have to get into the cause of them. Statistically, it's the overuse and misuse of interventions. If these are not part of the equation and labor/birth is left alone and is properly managed then the incidence of nonreassuring heart tones is very rare. In normal birth it's very uncommon for the baby to experience true heart rate decels that don't recover. If decels are noticed then they are watched and the mother is encouraged to try different positions. Sometimes it's the way the baby is lying (on the cord) that is contributing to the lower heart tones. Once mom changes position it recovers. No problems.

Nonreassuring fetal heart tones is the leading cause of emergency c-sections. And if unnecessary interventions weren't involved there would be fewer cases. Way fewer. Once moms that are usually nervous about the 'what if' scenarios are shown that most of the complications/scenarios they are accustomed to rarely occur in normal birth they begin to feel better and more confident about birthing outside the hospital.

Almost every possible complication that could arise can be effectively handled by someone trained and educated in handling complications. I take the approach that one is expected to know child/infant CPR. There are diagrams showing how the techniques are performed. Or, take lifeguards, they don't swim with you and hover over you thinking you're going to drown. No, they observe and leave you alone until something arises. If there's a problem they are trained to handle it and if it's serious you get transferred to the hospital. It's not much different from birth. One isn't going to just swim at pools or beaches that are within 10 miles of a hospital because of 'what if' scenarios that aren't really backed by evidence. People trust lifeguards to do their job and assess a situation. To handle it and if need be send you off to be treated at a hospital.

In the case of childbirth, there are various techniques and ways of observing a situation that can be done. All it takes is education and dispelling fear and the idea that problems can't be addressed if something comes up. Knowing how to spot a potential problem and address it is key. For instance, I know what too much blood loss looks like. I know what I'd need to do should I lose too much blood at birth. I know how to perform intermittent monitoring and know when to spot a problem.

Postpartum hemorrhage is another big one some fear, but is treated in many ways. Midwives carry pitocin and various tinctures that are oxytocic. They act by clamping down the uterus to seal off open blood vessels. This is exactly what would be done in the hospital. Pitocin shot in the leg. Putting baby to the breast will let the body know the baby and placenta have been birthed and will stimulate the body to contract and close off blood vessels.

Postpartum hemorrhage and nonreassuring heart tones are the two main concerns most have. These two are more common, but they are also very prevalent in births with a lot interventions.

For me, personally, I'm not nervous or worried about either. There's one situation that I'm more aware of. Not necessarily scared, but more aware of and have worked to educate myself on what to do in that situation. I know I'm fully capable of birthing big babies. It's not something I fear and I actually prefer big babies. I'm more in tune to shoulder dystocia. It's not always about the size of the baby. It has a lot to do with their rotation in the birth canal and getting the shoulder stuck behind the pubic bone. Bigger babies often have wider/bigger shoulders, thus more likely to get stuck behind the pubic bone. Understanding various maneuvers and techniques provide a lot of reassurance. Gaskin (invented by a homebirth midwife) and McRoberts maneuvers are done to remedy shoulder dystocia. Good positioning of the mother and baby helps in many ways.

Serious complications that require immediate attention/c-section:

Cord prolapse - less likely to happen if membranes are kept intact and baby's head is engaged or firm against the cervix. Baby that is ballotable/floating and has a long cord where membranes are artificially ruptured can pass a cord. It's very rare. Conditions have to be right in order for the cord to pass through before the baby. There are certain risk factors that can lead to or cause it. I was more aware of this complication during my last pregnancy because I had severe polyhydramnios which presents a greater risk of cord prolapse if membranes rupture. My midwife and I talked a lot about how to manage it and doing a controlled membrane rupture.

Cord compression - is usually noted during the second stage and heart tones are low and don't recover. This is extremely rare and can't be prevented. A friend of mine's daughter died just minutes before birth at the hospital. Again, rare. It's usually when the cord gets pressed between part of the baby's body like arm and the birth canal.

In any case, hemorrhage, shoulder dystocia and nonreassuring heart tones can be effectively handled in OOHB. These are the most common scenarios, especially when there are more interventions at play. If a poll is done on here I'm confident 'fetal distress' will rank as #1 in reasons for emergency c-section. And I bet a large sum of money a number of interventions were involved in practically every birth.

Reducing or cutting them out will greatly reduce the chances of these occurrences. In normal birth it is rare to encounter these situations. My midwife has a 8% transfer rate. Practically all of her transfers are first time moms. And the most common reason for transfer is exhaustion.

In cases where someone is scared of 'what if' scenarios and use it to challenge OOHB, I think it's good to encourage that person to write down specific complications and fears. Then, go research them. Look at the data. The specific complication, how to prevent it (if possible), the underlying cause and how to manage or treat it. If you're prepared going into it then you're more confident. Education, preparation, evidence based research, and confidence/trust can go a long way.
Another babyloss mother that I'm friends with lost her son in a homebirth and recently went on to have her rainbow baby at home. There are many like this. I *really* depends on what took place. Most times the outcome would not have been different. I know of another mama that had to call EMS shortly after her son was born because he was listless. Poor apgars. Come to find out he had a birth defect that went undiagnosed prenatally. Had DS1 not passed before labor I would have had him at home not knowing of his fatal heart condition. He would have passed during birth or shortly after.

There are situations that can't always be prevented. You just have to be prepared for whatever possibility. Birthing in the hospital eliminates that as we tend to put all responsibility on the birth attendant. The expert. If something goes wrong due to the cascade of interventions you can just be cut open and the birth attendant is absolved of responsibility. He/she is regarded as the hero. Everyone suddenly forgets the birth attendant's life saving measures would not have been warranted had he/she not intervened unnecessarily.

Trust in the process of birth. Do your research and mentally and emotionally prepare for it.
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Last edited by Aeterna; February 17th, 2010 at 09:28 AM.
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  #3  
February 17th, 2010, 01:25 PM
PixieQueen's Avatar Hi-Tech Hippie
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Having just had a "what if" at my homebirth, I can tell you that I don't think the outcome would have been better at the hospital. It actually likely would have been worse. I had a snapped cord (very rare, btw) and my DD lost blood and needed a transfusion. If I hadn't had a waterbirth, it wouldn't have been a problem. But because of the water she bled faster and they didn't see the end of the cord right away. Were it not for that, she would have been totally fine. At the hospital, if they had left me alone (not likely) I MAY have had a better outcome because I would have been on a bed and not in water, but that is the ONLY reason. If I had been at the hospital, they likely would have broken my water, which did not break until I was pushing. If they had broken it at 4 cm, as is standard, Tesla would have dropped sooner, and may have bled out inside me before I even delivered her. My midwife is pretty sure the amniotic fluid kept her floating until I could push her out in a safe amount of time. Or I would have ended up with a c/s (she was breech) if they'd broken my water and realized it, and she still could have bled because the Dr wouldn't have thought about a short cord and it would have snapped when they pulled her out. Or I could have bled, because I had an anterior placenta, so the Dr would have had to cut through it to get to Tesla. The number of "what ifs" at the hospital versus the *one* (what if I hadn't gotten back in the tub) at home let me know that I made the right decision for me, regardless of the transport. And if I should get pregnant again, I will be having another homebirth. And my DH agrees with me. On top of the fact that we didn't have a very pleasant experience with the hospital staff. And the aren't infallible. My friend's sister is the head nurse in L&D at the hospital we transported to. My friend told me that about a week after we brought Tesla home a baby almost bled to death because they didn't put the umbilical clamp on properly and it fell off. And nobody noticed!! So they had an otherwise healthy baby crashing and THEY COULDN"T FIGURE OUT WHY! Wth?! Nobody could see the blood soaked blankets the baby was wrapped in? So as long as you are comfortable with transport time (we are less then 5 min from the hospital anyway) I think you'll be fine. My situation was very rare. My midwife also told me I could still have homebirths and labor in water, I just can't have any more waterbirths. I am totally fine with that!

Sorry for the novel. I had more to say than I realized.
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  #4  
February 17th, 2010, 03:18 PM
ShaunaB's Avatar Mega Super Mommy
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In doula training they told us that even at the hospital it takes 20-30 minutes to set up the OR for emergency surgery. So if your home is located no farther than that from a hospital, you are covered on most emergencies. Your midwife would simply call immediately so that they can set up the OR before you get there. Of course, we know that true emergencies like that are rare and you usually have more time than that for a transfer.

Perhaps a meeting with a homebirth midwife is best for your husband. Then he can ask all the questions he has and get the absolute best information from the practitioner. Many times having trust in your provider will ease his "what if" concerns, because he'll know she's prepared. You should encourage him to bring up all of the "what if" scenarios he's worried about and then the midwife can address each concern.
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  #5  
February 17th, 2010, 05:17 PM
moon~maiden's Avatar Cheryl~ birth truster
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nothing much more to add, good luck convincing your husband!!!
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  #6  
February 17th, 2010, 05:41 PM
~ Christine ~'s Avatar Platinum Supermommy
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Thanks for all the info ladies! It's a long shot, but we'll see what he says!
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  #7  
February 17th, 2010, 06:00 PM
TheOtherMichelle's Avatar Platinum Supermommy
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LuxAeterna, do you have a link to that article? I'm compiling a vbac bookmark folder.

I'm seriously thinking about a home birth again, and plan on having a consult and bringing dh.
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  #8  
February 18th, 2010, 06:05 AM
Aeterna's Avatar Super Speshil
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Quote:
Originally Posted by TheOtherMichelle View Post
LuxAeterna, do you have a link to that article? I'm compiling a vbac bookmark folder.

I'm seriously thinking about a home birth again, and plan on having a consult and bringing dh.
The excerpt I posted comes from Marsden Wagner's Fish Can't See Water article. I hyperlinked it where it says "source."
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