WWYD if you went into labor preterm? - Page 3

[MittensKittens]

Originally Posted by ~Megan~

Perhaps my opinion doesn't count because I had midwife assisted, or rather midwife observed, homebirths.

But, IMO, medical care is there for medical events. Birth is not inheriently a medical event when its safe and normal. Premature labor and birth is not safe nor normal.

IMO, its not responsible to give your child at least adequate medical care to meet their needs. That doesn't mean you have to walk into the hospital lay down and take whatever they give you. But special circumstances do necessitate special care.

This would be one of the times in which I'd be thrilled and thankful that OBs are there and trained with all their machinery to help my baby be born safely.

In other words....Get Thee to a Hospital!

What would you consider to be premature labor and birth, though?

[Lousli]

Originally Posted by MittensKittens

Not 10 weeks, not likely at least . But it might mean the difference between 34 weeks and 36 weeks for instance, which could make all the difference. Again, I think trusting your instincts is probably the most important. Laboring and birthing at home and then transferring is also an option, of course.

Yes, I suppose it would be an option for some people. I understand that most people who UC are inclined to follow their instinct and make decisions based upon being in tune with their bodies. I guess I just tend to urge caution because I frequently read comments about big babies being fine or that 34 weeks means that lungs are developed enough. I've had one 4 pound baby (33 weeks) and one 5 pound baby (36 weeks). Both of mine were better off than my friend's 6 pound baby (34 weeks) who was on a respirator for 2 weeks after birth.

After watching my child spend 23 days in the NICU and seeing the other babies there, I would never even consider writing off prematurity as something not serious, no matter what my instincts told me. Now, as I said, I'm not a UC'er, so maybe my instincts aren't great, or I don't have a lot of faith in my body after my last two births, or whatever. I just very honestly feel that lung maturity is nothing to fool around with, and it wouldn't be a risk I'd be willing to take. IMO, there is a reason 37 weeks is considered term.

[flapjack]

For me, knowing that I tend to go postdates, anything before 38 weeks I'd consider premature and anything before 37 I would not consider outside of a hospital. EVER. For a typical multigravida who tends to have babies at the 37/38 week point, I'd probably consider an attended homebirth at 36 weeks but would be out of the door and streaking up the road to the hospital like a shot if I thought there was anything wrong.

It depends though. Are we acknowledging here that there is a significant risk of death for babies born prematurely, or for permanent brain damage, and that appropriate medical treatment will lessen that risk?

[KAT2006]

I am a NICU nurse in one of the biggest NICU's on the east coast. And 34 weeks is really, really early to be confident in their lung development. Yes, some babies are okay, but really MOST need help from a nasal cannula to a ventilator in some instances. Surfactant production is usually done by about 36 weeks, which is why term is considered 37. Respiratory distress syndrome (preemie lungs) needs quick attention, the babies that have interventions quickly after birth do much much better.
Also, preemies less than 35 weeks have a tendancy for apnea, problems with jaundice because their liver is immature. The biggest problem is infection though, going into preterm labor is not "normal". Infection is the biggest cause of preterm labor. The baby can come out pink and beautiful and yet a bad infection is brewing and can become very sick days later and they do not have any good immune system to fight it off.
I'm not trying to scare anyone....I am very pro NFL/birthing/etc. But this is one area that really deserves careful thought, and imo 34-35 weeks is simply too early.

[barefootpoetry]

I am not a UCer, just a HBer, but I would not HB before 36-37 weeks so I suppose it's roughly the same decision. IMO birth before then falls outside of the spectrum of safe, normal birth that you need to be in. Sure things COULD be fine, but there is an elevated risk of them NOT being fine with a younger gestational age. This is what hospitals are for. I personally wouldn't feel comfortable birthing at home, attended or not, before 36-37 weeks.

[~Megan~]

Originally Posted by MittensKittens

What would you consider to be premature labor and birth, though?

I wouldn't feel comfortable being unassisted if I went into labor before 35 weeks. 35 weeks and I'd still feel like I was pushing it.

My last two births were with my friend that is a midwife. She provided prenatal care (palpation, BP, and lots of talking) and she attended the births. She is a very hands off midwife though, as in she sits and watches acting as a support person if you ask for help and to step in if things become dangerous. Its actually Pamamidwife that posts here if you are familiar with her she is very pro UC.
I would definitely want here there if I went into labor at 35-36 weeks. My pregnancies have all been 37-38 weeks so I'd feel like something way off if I went into labor earlier than that.

I'm not having more children so this is all hypothetical but if I did and I went into labor prematurely I'd want her with me a support person in the hospital to help me determine which interventions we do and do not want.

[johannasonja]

with my ds i started contractions at 35 weeks and 6 days( if things had gotten sirious i would have stayed home), they went on for a couple days, so he was born at 36 weeks and 5 days and he was totally fine.

I would stay home everything after 35/ 36 weeks also going by my feeling.
And interestingly i knew at 30 weeks that this one will come around 35/ 36 weeks and i was right.

his weight was normal- 6 pounds and 11 ounces.
my first dd was 38 weeks and some days and only 5 and a half pound she was fine too so i dont think you can go by weight really.

johannasonja

[Romana]

37 weeks. My first was born at 38 wks and needed no help. 37 weeks is considered term, so if I was sure of my dates, cutoff would be 37 wks. That's for homebirth rather than UC, though. I might step it up to 38 wks for UC, because my midwife would have oxygen etc. at a homebirth but I would not have those supplies for a UC.

[OGirlieMama]

I'm not a UCer, but I want to echo Lousli's comments about not equating big babies with healthy babies. There's room for normal variation, but generally speaking, lung maturity is a function of gestational age and development and not one of size. Poundage does NOT equal maturity.

[Lisa85]

I think we all agree that 30 weeks is too early for a preemie to be birthed at home. I like the rest of the article, and also think the point she makes about dating a pregnancy is a valid one.

True, but she's forgetting it also goes the other way. While it's possible she's 33 or even 34 weeks instead of 30 weeks, it's also possible she's really only 26 or 27 weeks. A baby of that gestation already has it's odds stacked against him/her in a NICU. With little to no medical equipment born UC, a baby of that term just does not stand a chance and CPS SHOULD be called because that is medical neglect.

[MOMYS]

Sorry, a bit late, but I wanted to add my bit here as well.

I've had homebirths and hospital births and I'm seriously considering UC this time around. \

For me the cut off will be 35 weeks. I have had 1 baby at 35 weeks, 1 day; 1 baby at 35 weeks, 4 days and I baby at 36 weeks. All three were 100% fine. It would seem that I bake my babies a bit quicker :-), so for me 35 weeks would be my cut off.

[TiffanyPartyOf6]

Mines 37w. My dd was born at 35w6d at the hospital and was not breathing. After her I had 2 homebirths, one was a UC.

[Luv2bemommy]

I would say 37-38 weeks. For me though I cook my babies later, like 42 weeks so it would be very strange for me to experience a baby born that early and I think that my lack of experience with babies that small would make me wanna go to the hospital. Of course I would trust my instincts too on the matter but I can't imagine having a baby here before 37 weeks UC.

[MittensKittens]

Originally Posted by Lisa85

True, but she's forgetting it also goes the other way. While it's possible she's 33 or even 34 weeks instead of 30 weeks, it's also possible she's really only 26 or 27 weeks. A baby of that gestation already has it's odds stacked against him/her in a NICU. With little to no medical equipment born UC, a baby of that term just does not stand a chance and CPS SHOULD be called because that is medical neglect.

While I agree up to a point, I also want to note that there are more than a few countries that have policies not to intervene if a baby is born at 26 weeks, and if the baby can't survive naturally outside of the womb, then nothing is done. Would you say that is neglect too?

[Lousli]

The odds of a 26 week preemie surviving with NICU care are 80-90%. Without NICU care, probably close to 0%. If you are living somewhere NICU care isn't available, that is one thing. If you live where NICU care is available and your child has an 80% or higher chance of survival with that care and a 0% chance without it, and you decide not to use it, that, in my opinion, is neglect.

Mt stats came from here, after just a quick internet search:
http://www.becomehealthynow.com/arti...enpreg/1156/3/

I'm sure there are other sources of statistics that may give slightly different numbers. The above says it is referring to the NICU care available in the late 1990's. I wonder how much more sophisticated the care has gotten in even the last decade?

[rixafreeze]

I'd say my cutoff would be between 36-37 weeks. Definitely 37. My daughter came at 38 weeks exactly and so I *might* push it back to 36 depending on a lot of factors. I would watch the baby like a hawk, though, paying special attention to respirations, how well/if the baby is nursing (a lack of interest in nursing can indicate underlying problems), etc.

[elephantine]

Originally Posted by Moonprysm

Ok, sorry it took so long, but I finally found the article I was talking about:

http://web.archive.org/web/200202230...e%20Childbirth

I read this yesterday and now just wanted to come and post my experience. I know most people chimed in and said that 30 wks was definately too early and I wanted to agree. I had fraternal twins just three days shy of being '30 weekers' and they would have most certainly died without intervention. I'll explain.

The author of the article sounds totally well-meaning but what she is proposing is much more fairy tale than reality, for a 30 weeker preemie anyway. When my babies were taken off the ventilators after it was clear that their grossly underdeveloped lungs were not collapsing(about 2-3 days after the birth) I was able to hold them for a short while. I was very eager to do kangaroo care... and really depressing for me at the time, but they did not do well with being touched and required higher oxygen during kangaroo.

My twins were very different -- one was average in weight and length for a 29 weeker, the other was more the size of an average 27 weeker... and while size is no factor, having an early gestation *and* a small baby can mean more complications and usually a longer hospital stay.

Feeding -- a few days later, they started off with 1 cc of my milk and for my smallest baby, it just sat and festered in his belly... it wasn't going anywhere. The only two things a mom with a baby in the NICU can actually do -- kangaroo and provide milk... it is just dismaying to see that as a mom you just don't have what is necessary to keep a baby of that gestation alive.

And yes all the sticks and tubes and wires just sucked... but no one was rough or heartless.. I don't think the b*tchiest NICU nurse out there is going to be rough with such a small baby... even light touches can leave bruises. Don't get me wrong, I hated that it happened.. I hated that they were there... I have a lot of doubts about the necessity of that "emergency" c-section that I was pushed into, I was angry with the docs who had provided substandard prenatal "care"... but it is what happened and what we(the kids and I) had to endure.

For such tiny ones, a level III NICU is the best shot they have at life. Just like if any one of us were to birth a full term baby with an imperforate rectum for instance -- we would have to take our baby in to have emergency surgery or if any one of us ruptures our spleen in a car wreck -- no matter how much we dislike hospitals or how germ ridden they are(and they are) -- we'd be in there getting emergency surgery, life support if necessary etc. Just doing what we have to do to survive.

I will say things got much much better when they hit about 32 weeks gestational age... my bigger baby came home around 35 weeks GA on no monitors and weighing just over 4lbs and my other child came home a couple weeks later at 37 weeks gestation(due to his size and coming down with hypothermia when his brother went home and left his side) and weighing 3lbs 12 oz and on no monitors. We had follow up care for eyes, heart etc and we needed one surgery to correct double hernias and that was it.

They are late talkers and one was a late walker... but they have no serious issues. So, that is my experience... 32 weeks is a world different than 30 and 34 a world different than 32.

[justmama]

I wouldnt' be comfortable until at least 36 or 37weeks. I had a 33 weeker and a 34weeker who would not have survived without intervention from a hospital. I know a mom of a 35weeker who wouldn't have survived without intervention. But I know another mom of a 35weeker who was just small and sleepy but only went to the nicu for observation for a few hours. She went home 24hours after the birth. It varies SO much. I wouldn't feel comfortable taking that chance that my child may come out with immature lungs at any less than 36-37weeks gestation. Even then it's a risk. And you don't know until they are born. So it's not worth the risk in my opinion. My 33weeker was a full 1/2lb smaller than her sister and fared better. They both spent the same amt of time in the nicu but for different things and my 33weeker came home wireless while my 34weeker was on an apnea monitor until 6 months old.