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Questions to ask my midwife


Forum: Home Birth

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  #1  
March 28th, 2008, 01:56 PM
*Vero*'s Avatar Platinum Supermommy
Join Date: Dec 2005
Location: Ottawa Valley, Ont. Canada
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Ok so since I live so far from the hospital I really want to research into this before I just jump right in (which I so would have done if the hospital that is 5 min away was equipped to deal with birthing emergencies)

So DH has agreed we can consider it as long as I come up with a list of complications that could arrise from labour and delivery so that I can get answers from the midwife as to what we would do in each case... It's a smart way to think, and I totally agree with it especially if it means everyone is comfortable with the decision that way!

So what are the complications that can occur during labour and delivery?

- I can think of a few things such as the mother hemerging
- The baby being breach (which we will be getting an ultrasound before hand and may not even attempt a home birth in that circumstances)
- Foetal distress (though I hear this is less common in home birth... however I'm sure it does happen.. so it is good to know what the plan is in that case)

What are the problems that can occur with the placenta? A previous ultrasound discovered that my placenta is a bit strange... lol that the cord is not attached to the middle but to side... the midwves could not see why this was a concern (but the ultrasound tech did list it as a concern and had recommended another ultrasound at 36 weeks...)

I have researched information on ambulance respond time in my area and such and am quite comfortable with that... My midwifery practice also lists on their website, the option of giving birth at my local hospital. I think the reason they never actually gave me that option was because they were planning on having privileges at the other hospital by then. The way I look at it though is that they seemed to think it was safe to deliver there... so it really shouldn't be that unsafe to deliver 5 min. from there!
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  #2  
March 29th, 2008, 04:44 PM
LaLa's Avatar Platinum Supermommy
Join Date: Jun 2005
Posts: 11,576
Well first things first, when you say the hospital nearby isnt equipped to deal with "birthing emergencies" what do you mean? Do they have Labor & Delivery just not a NICU? No OR?

Second - some of the things that can occur:

Fetal distress (chances are low without the interventions that are common in the hospital such as pitocin, epidural, narcotic pain relief, and also are lower with mobility).

Placental abruption - very rare, and even more rare without the interventions listed above. NOT something you would really know about before hand. Something your MW could watch out for, and would have time to transport or in most cases. A call to the hospital would have them on alert & ready for you when you arrive.

Uterine rupture - again very rare, and especially rare without intervention. Also not something you would really know about before hand. Your MW would be alerted to the signs & its something you would have time to transport for in most cases. Again - a call to the hospital would alert them that youre on your way so theyd be prepared when you arrived.

Hemorrhage - once again, the chances of it happening & the severity are much lower without things like pitocin. Also something they usually are equipped to handle at homebirths, and its something you usually have time to transport for. Hemorrhages are most severe 2 - 3 days after birth when there is a retained placenta which is actually more commonly UNdetected in hospital births b/c you are typically discharged before signs appear & hospital birthers usually dont have another checkup until 6 weeks once theyre discharged, unlike homebirht moms who remain under their MWs care & have more frequent checks in the weeks following their birth.

Placenta accreta - where the placenta grows into the wall of the uterus. Rarely detected before birth, and an extremely rare condition. Its seen far more often now (your increases go up by a phenomenal rate with each cesarean), when it was almost never seen before the rise in cesareans. Its also very dangerous, but usually enough time for transport. I know a MW whos handled a case of accreta in a homebirth & they transported without concern. In fact, had the mother been in a hospital & given pitocin it likely would have been fatal.

Cord prolapse - something that isnt restricted to happening at birth, so your choice of location for birth isnt an issue. Its only really an issue with Premature Rupture of Membranes or Premature AROM. Agani - this isnt happening in a homebirth, so likely not an issue. Its something youd have time to transport for, though very very carefully. Even moms who are planning a hospital birth could have this happen at home though.

Breech - your state laws probably dictate this & your MW will be trained to know the exact position of the baby without even needing an U/S.

Shoulder Dystocia - not very common & more easily handled by a MW - so youre safer at home (or anywhere where a MW is lol). Drs are known to solve it by breaking collar bones, though some OBs are trained in the Gaskin Maneuver - named the Gaskin Maneuver after Ina May Gaskin, world famous Midwife The first and only MW to have an obstetrical maneuver named after her. She learned it from Lay Midwives around the world Its extremely successful & Ina May who has delivered thousands of babies with a less than 4% cesarean rate has never had a problem stemming from shoulder dystocia.

Hope that helps Those are all the issues I can think of. Some peopel talk about things like cord around the neck, etc - but thats actually very common & rarely a problem. MWs can usually hear things like cord knots (true knots) etc - and are trained to handle them. natural births are also better for such situations b/c youre not placing undue pressure on the cord with things like pitocin or a dictated position of birthing. Mom will usually instinctively move into a position that eases pressure off the cord. And anyways - they do intermittent monitoring, which has shown to have the same rate of success when judged by birth outcomes against continuous fetal heart monitoring, which has far greater risks. Same benefits, so choose the one with the fewest risks naturally

Lala...
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