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-   -   Worst Case Scenerio (http://www.justmommies.com/forums/f341-home-birth/604113-worst-case-scenerio.html)

illinoismommy June 9th, 2007 08:14 PM

Tell me what sorts of things could go wrong that you have to transfer to the hospital for?

How far from the hospital would you feel comfortable with, and why?

I am 45 minutes from the hospital and that scares me.

vegaburm June 10th, 2007 05:21 AM

I'm not an expert, but I believe the main things that require transport to the hospital are hemmorage and resucitation of the baby. Also, cord prolapse, though that is quite rare. One midwife gave me her birth stats and of 335 births she had one of each of these that had to be transported. Other things you would know about ahead of time. For example, a breech at home cold be risky and if it doesn't go well might need to be transported, but you would know that ahead of time. At 45 minutes I probably just wouldn't attempt that at home!

I'm 20 minutes fromt he hospital and that was worrying me, makes me feel like it isn't so bad with you at 45! But, like i said these things are very rare. You midwife will probably have IV supplies, stuff for resucitation, etc. Talk to her abut it and see if she is prepared for these possibilities.

illinoismommy June 10th, 2007 07:43 PM

Hemmorage-- that is extra bleeding? How much qualifies? I was bleeding enough after my natural hospital birth that they ended up giving me something for it....

Soap Lady June 11th, 2007 05:27 AM

Quote:

Hemmorage-- that is extra bleeding? How much qualifies? I was bleeding enough after my natural hospital birth that they ended up giving me something for it....[/b]
2 cups is considered hemmoraging, but remember that blood spread out can look like A LOT more than it is. My mw had me taking alfalfa tablets for the month before the birth because it naturally raises your vit K levels and reduces bleeding. I'm sure there were other factors involved, but the mw called mine "an almost bloodless childbirth" which she had rarely seen. It certainly wouldn't hurt to take alfalfa as a preventative for blood loss.

I would only go to the hosp for a life-threatening complication such as prolapsed cord, hemorrhaging, etc. I would feel comfortable being hours from the hospital because those complications are rare. But I'm also a believer that a woman needs to labor where she is comfortable. If you're not comfortable being so far away, maybe there is a friend's house you could go to? Just a thought. I have a friend who went to her sister's house to birth because the midwife wouldn't travel all the way to my friend's house.

MrsPil June 11th, 2007 04:15 PM

My transfer criteria was hemorrhage and cord prolapse, though I warned (and was quite serious when I did so) that if cord prolapse was a problem that someone else could call an ambulance while I boiled our knives and did my own c-section.

Butter June 11th, 2007 08:10 PM

The majority of failed homebirths are actually transfers by mother's request (want drugs, monitoring, whatever) and are not for emergencies.

CharmieCM June 13th, 2007 05:57 PM

I've actually never seen a homebirth transport that was the mother's request, except in the case where everyone is talking about what the next step is and the logical next step is the hospital.

Most transports that occur in labor ARE, however, non-emergent. Things like positioning of baby, maternal exhaustion, a tear that's beyond the midwife's suturing skills (or that requires antibiotics), concerns about baby's heart rate (yes, even THAT is usually a non-emergent transport).

But you're asking for the "worst case scenario." Okay, so lets say that you have a cord prolapse (about 1/1000 chance, and it would be much more likely with a baby who is in an odd position than with a head-down, engaged baby). A cord prolapse means that baby's life supply is possibly going to be cut off by the pressure of baby's head on the cord, which would cause the baby to suffocate, in effect. If one knows how to deal with this circumstance (put your chest on the ground, your butt up in the air and have someone stuff their hand inside of you to push baby up off of the cord, and drink about 2 liters of water immediately so that your bladder will provide some cushoin for the cord as well and DO NOT MOVE FROM THIS POSITION UNTIL YOUR BABY IS SAFE AND SOUND ON THE OUTSIDE OF YOU), and how to have the hospital ready to do a "splash and gash" c-section the minute you are rolled through the door (call ahead, tell them you're on the way, that there was a cord prolapse and that they MUST MUST MUST be ready to GET THIS BABY OUT immediately), 45 mintues will not be the difference in life and death for your baby. Now, if no one knows how to handle the situaiton and the hospital dilly-dallys around, then yes, it will mean life or death. In any case, most hospitals have a 30 minute response time for c-sections, even if you're in a labor room down the hall and they determine that you need one.

Other circumstances, like hemmorhage or retained placenta, can be emergencies but are usually much less dramatic. In the case of bleeding, your midwife has drugs to get it under control and the EMTs will also know how to deal with bleeding (whereas they sometimes don't really understand why you've got your butt in the air in the case of a cord prolapse). The retained placenta, as long as you're not bleeding, is not an emergency. I've heard of women waiting 6 hours (after transport) for a d&c to remove their placenta.

Butter June 15th, 2007 07:37 AM

Quote:

I've actually never seen a homebirth transport that was the mother's request, except in the case where everyone is talking about what the next step is and the logical next step is the hospital.[/b]
Maybe I should clarify that for the midwives that delivered Cameron and Fritz said that's the majority of their transports.

MissyPrincessEha June 16th, 2007 03:47 PM

I second what the other ladies said.

You have to keep in mind that you have the stats on your side or in your favor when you homebirth with a healthy pregnancy and baby. Even if something strange is going on that isn't quite normal...I have seen the woman's body labor and birth in a very different way to accommodate for whatever it is. It is a very NEAT thing to see the mom and baby work together naturally when they don't have all that crap to go up against or to change it.

98% of women can expect a wonderful homebirth. This does not mean that "normal" deviations will not happen. But they are normal and can be helped.

When you step into the hospital....just the very act of being there changes it (labor). And your hormones start acting all wacky and things veer in a new direction. Add on to that medications and synthetic hormones in strange doses not found in nature and you have set the stage for trouble. Your small chance or something happening has now increased.

Birth is a very finicky thing. It wants to do what it should and it will...if it has the chance. :)


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