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Well some of you may remember me posting on this board a few months back considering doing a homebirth.. I thought it would be very safe as I live 5 min from a hospital... Well after talking it over with my midwife, I learned thatthe hospital that is 5 min away is not equipped to deal with emergencies and I would have to go about an hour away in the case of an emergency... The midwife had also described the hospital facilities and it sounded like a very nice place to give birth (similar to the hospital I gave birth at previously)
Well I am now almost 34 weeks along and my midwife practice still have not gained the hospital priviledges that they were supposed to have last November... What they are doing now, is working in conjunction with a family doctor and will be starting to have me seeing this doctor every second appointment very shortly.... He will be the one who is delivering the baby and the midwife will be playing the role of "an overpriced doula that is covered by healthcare" (her words) I was a bit iffy about that to start with.... I started asking her about wether I could have early dismissal like I did last time.. she said I could... but that I would have to not only make it very clear to the doctor but fight the nurses and insist that I be dismissed early and insists that they do not prick my baby for the PKU test as it is pointless before 24 hours and the midwife will do it during the home visit anyways...
Put on top of that the fact that the hospital I will be delivering at is 45 min away.. I had a quick labour with my first and my DH works 1 hour the other direction... and the fact that I have absolutely no one that I can set in stone as someone who will be available to watch my daughter (but I may be able to get someone to come in a few hours later and help DH keep an eye on her at home) and I'm very strongly re-considering home birth...
I just don't think there will be any complications... but if there are the proper hospitals are so far away... What do you think? How far did/will you live from the hospital when you had/will have you home birth?
Well, Im in a similar situation - I have a hospital nearby but they cant deal with anything more than just a standard thing like if labor had stalled, etc. For true emergencies, the nearest hospital was about 45 miles away (an hour with traffic and theres always traffic even in the middle of the night b/c theyre doing major construction on the interstate, a lot of it happening at night).
Heres how I saw it: the vast majority of transports for a homebirth are for non emergent situations - slow progression, mom decides to get an epidural, observation is needed b/c of suspected GBS infection, etc. THe midwife has everything on hand to be able to moderate the situation for 30 mins to an hour (the time needed for transport) plus a hospital 5 mins away means an ambulance is also 5 mins away.
IF I were to deliver - I would have delivered at the hospital that wasnt equipped, and so do thousands of other women. It rarely deters them, right?! And of course, they could perform a cesarean if it was necessary, but we'd end up transporting and the homebirth issue wouldnt be a factor there.
So - then to consider the things that usually do require emergency transport: placenta abruption - that can happen without you even going into labor, so the fact youre having a homebirth isnt an issue & its a very rare occurance. Hemorrhage - can be controlled in the time it takes to transport - its extremely rare for a person to bleed to death in less than an hour when emergency medication is on hand & in this case - the fact youre haivng the baby at home is irrelevant. In fact, postpartum hemorrhage deaths decrease with homebirths for the simple fact that MOST of them are from retained placentas. Retained placentas are more frequent in hospitals due to the high use of pitocin & they often present problems after the 3rd day - when youve already been discharged. HOspital birthing moms get observed for 3 days (if theyre lucky) then sent home and arent seen again until 6 weeks so its rare that retained placentas are picked up. HBing moms are visited frequently by their MW (same for BC moms), and so they are more likely to have the condition recognized by their provider & treated before it's a problem.
Most of the "drop dead" emergencies are things that can happen whether youre in labor or not and so homebirthing doesn't change how long it takes to get to a facility that can handle it. MOST transports are for non emergent situations, so an hour distance isn't a big deal. If that "emergent" situation requiring NICU or advanced care is needed, most moms have to transport even from hospital to hopsital.
Hope that makes sense.
In the end - we had a great homebirth - my labor was only 4 1/2 hours. Things went great & in hindsight, I think things would have ended up badly in a hospital. My cx's never settled into a pattern, and it was pretty often that Id get 10 & 15 min breaks, or really short contractions. No doubt inmy mind theyd haveput me on pitocin. I had a small bleed after the birth, which the MW handled immediately without concern, and had I had pitocin that would have likely been a true hemorrhage rather than a slight bleed b/c the body isnt able to clamp down the uterus when youve been given pitocin like that. And - b/c of how fast my labor progressed, any pitocin would have made it unbearable and easily could have caused fetal distress. With pitocin Id have been limited on my movement, and I'm POSITIVE my baby wouldnt have moved out of the posterior position had I not been on my hands & knees.
ESTHER GRACE WAS BORN ON MARCH 23RD, 2009: 4:15 PM, 9 POUNDS, 20.5 INCHES. ANOTHER WONDERFUL HOME WATER BIRTH!!!
The world today is upside down because there is so very little love in the home, and in family life. We have no time for each other. Everybody is in such a terrible rush, and so anxious…and in the home begins the disruption of the peace of the world. -Mother Teresa~
Well I emailed my midwife and told her I am once again re-considering. I asked her to requisition an ultrasound so that I oculd book an appointment since she mentioned she would want me to have an ultrasound if I was to do a home birth... I told her we would discuss it more at our next appointment (which I have at about 36 weeks) but that I wanted to get going on booking the ultrasound since my local hospital can sometimes take weeks to schedule one...
So it is still not decided, but I am determined to really see what my midwife has to say now that she knows that she will not have the hospital privileges in time... I can't help but wonder if one of the reason she was not totally on board with a home birth last time we talked about it is because they are fighting so hard to get hospital privileges and they thought they would have them by then!
And I do admit, that if they had the privileges, the hospital may have been a better compromise since it would have helped DH feel safer while having the calm of a midwife birth (I know this is not the case everywhere, but here a midwife birth at the hospital is pretty much like a home birth... just with more machines around that tend to make people (such as DH) feel safer... I loved my hospital birth experience with my daughter.. but I never had to set eye on a doctor... no nurse ever came in the room and I was allowed to leave and go home within hours of giving birth.) But with this midwifewry group not having privileges I think I could be setting myself up for a very different experience!