hard homebirth/or not decisions

[kimdo]

Hello mamas,

I am writing to find out if anyone can share experience on choosing what to do for baby #3 after 2 semi-traumatic homebirths. . .

Here is the scene: #1 born at home, no risks, but long labor, long pushing, ended up with cord around neck and shoulder dystocia, babe had to be resucitated after she was born not breathing. I hemorrhaged, we both ended up in hospital afterward (probably didnt' have to go, but we were scared and didn't know what to do!) baby 8lbs 14 oz

#2 born at home, with different midwife, long labor, (probably prolonged b/c of my fears) long pushing, big baby stuck again. Midwife struggled to get her out (this is after the head was birthed). She did not have to be resucitated. 10 lbs 10 oz.

So, wasn't going to have another one, partly b/c of scary births. But, couldn't resist, and so here I am , 4 years later (due may09). I guess I am slated to have a 12lb+ baby, who will likely get stuck (maybe the shape of my pelvis??). So, to birth at home, or not. . .that is the question. Honestly, I am scared. If the baby is stuck for too long, with too much O2 deprivation. . . not good. So, wondering if anyone else has had an experience where they needed to decide what to do after a scary homebirth for subsequent births. Really, I cant decide why the hospital would be better except that if baby needed to be intubated and resuscitated right away they have folks there that can do it quickly!! I'd love to hear some advice or stories. . .

PS I love home births and try not to share my story in too much detail to those that haven't birthed at home yet, b/c I still advocate for homebirths to everyone I meet. For most of us, it is the way to go-- perfectly safe, but for some of us, . . . perhaps not?? !! I dont' know

Kim

[JamieCatheryn]

Shoulder discotia is scary and presents dangers wherever it happens and with a baby of whatever size. If I expected it as a likely possibility and opted to birth at home I'd be sure to have at least 2 very skilled and relatively physically strong midwives on hand to help with maneuvering, plus assistant(s), and have resuscitation equipment and O2 and everything there ready just in case. If I had to birth in the hospital with that risk I would fight tooth and nail to keep that setting from adding extra risks: I'd fight to stay off my back, off all drugs, and with nothing strapping me down or tying me up in pushing to prevent performing the Gaskin maneuver, etc.

What do you think? How would you feel most comfortable? Do you have midwives available you are confident could help you at home should this arise again? Would you have the freedom to progress in the hospital in a way that wouldn't make things worse?

[wbg]

The best place for you to give birth, is the place you feel most empowered to have the birth you want. If you are able to give birth at home with an experienced midwife and feel safe and secure then thats what you should do. As the pp said, be prepared with skilled help, resus equip etc. Homebirths are magical and you have had two homebirths that produced your two beautiful girls. However, if your past experiences are going to hinder your progress and take you out of your secure and safe zone, then I would do whatever it takes to give birth in a place that makes you feel wrapped up in a warm and secure safety net. Perhaps a room across from the hospital, or even at a hospital. I agree that with your history, you can be set up to have a medically managed birth. However there are still a few hospitals that have supportive OBs, midwives etc and if you arrive there prepared with the best possible support team, and having been through your wishes in advance, there is a great chance of you having a beautiful birth experience. You know how your body responds in labor and are less likely to be talked in to things unnecessarily. Do your research and find the best team, including someone to advocate firmly on your behalf. I have certainly read quite a few positive, natural hospital birthing experiences here on MDC.

Follow your instincts, trust your gut and you will find the best place for you to welcome your little one. All the best...

[cristeen]

Originally Posted by kimdo

Really, I cant decide why the hospital would be better except that if baby needed to be intubated and resuscitated right away they have folks there that can do it quickly!!

One of the first questions you should be asking any prospective MW should be whether or not they're certified in neonatal resuscitation. IMO, if they're not, they shouldn't be attending births as an "expert", and you should take that as a hint to look elsewhere. As for intubation, unless the baby has a malformation, or needs prolonged help breathing (as in hours of breath support), intubation is rarely indicated, and can do more harm than good.

As to where to birth, like the pp mentioned, I think that should be dictated entirely by what you feel comfortable with. I think if you're going to consider a HBMW, that you need to be honest and upfront with all the midwives you interview (and you should interview several) about your previous experiences and your fears... see what they say. Their reactions to that information can tell you a lot. Are they dismissive or supportive? Do they offer suggestions or just tell you to work it out, etc. Find someone with both the training you need to feel comfortable (ask how many dystocias they've seen and what they would do for one), and enough empathy to support you through your fears. And it may be that you would benefit from having a doula attend, whether a HB or hospital birth.

[Gena 22]

That's really a tough decision. Remember that a hospital birth is not without risks. A safe homebirth might be your ideal, so do what you can to find that. As a PP said, interview several HBMWs. Get online and talk to mothers who've birthed with them before. Most importantly, make sure she has the equipment you might need.

Knowing how a MW will do in a tough spot is very hard to guess ahead of time. All I can say is ask a lot of questions. Lots and lots! I'm a fairly bad judge of character. I just want to think the best of people. My husband is usually better. But we were so excited and naive about our twin homebirth that we ended up with a MW who wasn't right for us. She misunderstood me, and didn't have the IV I desperately needed after many hours of labor-related vomiting. Fortunately she left for a vacation (which I knew about ahead of time) 2/3 of my way into labor.

Her back-up MW was as different as night and day. She swept in, got me hydrated and brought those babies out. She was so skilled, commanding presence but gentle when she needed to be. No tears, hermorraging managed, and two perfect babies!

The comparison between these two MWs is what gives me the most pause when recommending a HB. With the second MW, I'd recommend a HB is almost everyone. With the first, I'd guess her transfer rate is awful high and wouldn't refer anyone I cared about.

So how do you get the care you need ahead of time? That's an answer I haven't found yet. Lots of critical thinking and lots of research.

Hope it works out and you have a safe and happy birth, wherever it may be. As my mom says, it's all about getting the goods!

[kimdo]

Hi there,

I thank you for your input. A lot of questions yet, still more to think about. but I have thought about some of it. One of the reasons I am still pondering homebirth is that I am not comfortable in the hospital (and this after completing two clinical rotations as a nursing student in recent months on the OB unit of a local hospital). But, I am comfortable withthe doc that I am seeing -- a family doc, that I know, she had her kids at home and promotes all of the parts of birth that I like (no interventions, mom and baby can be together, etc.) even at the hospital.

Trouble with choosing a midwife, is that there is only one up here. She is the same one I had for my first birth, and she was quick to get me in hands and knees, remove the cord and get baby out. As for resucitation, obviously, she resucitated her, but she only has blow-by O2, no bag and since being in the hospital, I have seen and heard of several newborns being bagged for several minutes with O2 on to get them started. We did manual CPR on my first. Who knows, I see the doc and the midwife again next week, so I can ask more questions. I wish the right answer would just fall out of the sky and bonk me on the head. .. this could be the most normal birth I've had, maybe the baby will practically fall out calling my name!!

Kim

[mom2tatum]

If it were me, hearing all you said, I would probably keep the hbmw plan as option 1 going into labor...but have that wonderful doc back up at the hospital if you are home and feel any emotional discomfort with the situation/long labor you could choose transfer at any point. However, going with plan 1, I would do the following to assure the most comfort for myself physically and emotionally preparing for this labor:

- make sure the mw has the best res. tools avail., has another person with her whether it be another mw or apprentice to help in delivery and after, and is comfortable delivering a large baby that may again experience SD and possibility need res.
- get regular chiropractic care by a trusted chiro along with reg. pelvic/back exercises to assure you're doing all you can to prepare your pelvis.
- take some real time to prepare yourself mentally and emotionally for labor - whether it be daily yoga at home, yoga classes, hypnobirthing/hynobabies, etc.
- read or re-read Ina May's two books of birth stories...to remind yourself of all the possibilities of birth and all the times SD is mentioned and successfully delivered with or without res.

Realize that it may not be a question of whether the hospital or home is going to be safer for your baby's birth and well being, but it may be the place you feel safer laboring and birthing. That may be the real difference, because I have a feeling that your mw would be more prepared to use the gaskin maneuver and use it more correctly than any doc in a hospital.

Wishing you peace with your decision.

Lori

[Gena 22]

You might want to do a little research about third births. I know my mom had some trouble with her first 2, but that her third, my sister, was big and just about born in the car she came so fast. My MIL had her first HB on #3, and it went very well.

Could be that your third will shoot right out, waving at you!

Hope so!

[LilacMama]

How far do you live from the hospital? One (maybe) good option for you would be to labor at home for a very long time and then go to the hospital (the old --- "show up pushing" plan). Obviously you'd have to be cautious with this plan, but if you don't live too far away, it can be a good one.

[CanidFL]

What about a birth center? That might give you the wonderful midwife relationship and trust with an environment that feels a little more secure than home.

I second the advice of seeing a chiropractor through the pregnancy. My chiro gave me a study that had great results with length of labor and regular adjustments.

[cristeen]

Originally Posted by kimdo

As for resucitation, obviously, she resucitated her, but she only has blow-by O2, no bag and since being in the hospital, I have seen and heard of several newborns being bagged for several minutes with O2 on to get them started. We did manual CPR on my first.

I don't want you to feel like I'm trying to dismiss your fears, because they are very real... but this is something we discussed in class recently. Even those midwives who have bags often don't use them to resusc for the simple fact of expediency. We had several midwives who have been practicing for decades who carry bags but stated in class that the few times they have needed to resusc, they never reached for them. On a neonate, getting a good seal with a mask can be difficult, but doing the same with your mouth is much easier. Most midwives don't want to pull it out and set it up beforehand because it can frighten parents and "borrow trouble", and when the baby is here and having difficulty the midwives don't want to waste time pulling out and assembling a bag when that would delay ventilation... and really, CPR needs no equipment.

I know a lot of bags are disposable (one-use) bags, although they are often reused... maybe look into getting one of those to keep on hand if it makes you feel better?

[kimdo]

Originally Posted by CanidFL

seeing a chiropractor through the pregnancy. My chiro gave me a study that had great results with length of labor and regular adjustments.

I like the idea of seeing a chiropractor. I will have to check into it. I have never thought of that as possible treatment to improve labor. How many of you have done that?

There are no birth centers in the area, and the hospital where my doc works is 2 hours away. but my midwife has said that I could just labor or labor and birth at her house in the town where the hospital is. So, There are safe possiblities here. And, the mouth to mouth part of resucitation makes sense, the quicker, the better!!

I really appreciate all your input. What a great group of women!


Thanks,Kim

[CanidFL]

Originally Posted by kimdo

I like the idea of seeing a chiropractor. I will have to check into it. I have never thought of that as possible treatment to improve labor. How many of you have done that?

There are no birth centers in the area, and the hospital where my doc works is 2 hours away. but my midwife has said that I could just labor or labor and birth at her house in the town where the hospital is. So, There are safe possiblities here. And, the mouth to mouth part of resucitation makes sense, the quicker, the better!!

I really appreciate all your input. What a great group of women!


Thanks,Kim

We really need more birth centers in the US. I hate that women have to choose home or hospital when they aren’t comfy in either.

The study I read on Chiropractors and labor was the average labor was reduced by 3 hours in length with regular visits. It could vary with each patient though. I only have my own experience to go by but I went to the chiropractor every 2 weeks from 6 months on and my labor was under 3 hours. Who knows if it helped or not but I sure will go back with my next pregnancy.

There are other things you can do like squatting, strengthening your back (go on hands and knees then push your stomach out towards the floor and then pull it up and make an arch in my back), kegels, swimming, not sitting in the reclined position, etc that can all help get baby in a good position and keep you fit. I think for you, an important step will be working through your fears and feeling at peace when you near labor. Talk about everything with your midwife and really get the answers you need to feel safe.

ETA: If you do see a chiro, get a recommendation from a midwife and make sure they are qualified to work on pregnant women! Your joints are very loose while pregnant and the adjustments need to be very gentle.

[MsBlack]

You've gotten some great advice here. All I would add is that you don't need to have another extra large baby. Be much more watchful of your fats and sweets, work hard to eat lots of protein and fresh foods but to limit your dietary indulgences. Does not have to be a 'high protein' diet per se--just saying that it's best to fill up on proteins, fruits and veg and whole grains, and ingest your fats and sweets sparingly. I know a mom with a very similar birth/baby history to yours, first was 10lbs, second was over 11 and there was shoulder dystocia. But with the third she just ate as above (in her case, mainly eliminating ice cream ) and 3rd baby was only 8.5. Still plenty big to be a bit chubby and very healthy! Just not such a moose.

So, no need to feel that you are doomed to have another, even larger baby this time--or even one as large as your first 2. Pay more attention to those calories--and take up regular exercise like walking, if you don't do so already. This doesn't mean you have to be too pure, or deprive yourself utterly--just be very sensible with your eating this time.

You know--even with your history, I would not birth in a hospital. Your babies would have been put through so much more and likely a lot of needless treatments in the hospital, and some of those treatments could have caused more harm than good, leading to MORE time in the hospital. And your birth doc really won't have much say over what happens to baby once NICU staff get their hands on baby. Being home, even if it seems scary without all the hi tech gear, has distinct advantages for the baby whose beginning is stressful.

And oh yeah, one last--you sound like a mom who needs to avoid any/all labor and birth positions that put any pressure at all on your sacrum/tailbone. Hands and knees, kneeling, squatting, standing, sidelying, etc for delivery. And plenty of movement during labor--hula, swaying, lunging, pelvic rocking to help baby move down into best position for easy birthing. Stay off your butt as much as possible, don't even think about delivering in semi-recline!

[mom2tatum]

chiro search suggestion

I wanted to seriously recommend looking on ICPA for a chiropractor because the ones through there usually shard the same holistic philosophies and are more skilled at adjusting pregnant moms and babies and children - which IMO would be extremely important for your other two as well due to their births. I mentioned your situation to my chiro and he said right away two things - ask her where she lives and he'll try to recommend a specific chiro if he knows or to look on ICPA and two, he said that you must get in to see a chiro and so should your kiddo's just as well.

Just a note, my own birth was traumatic and I was pulled out with forceps...as an older child got diagnosed with scoliosis and now as an adult it causes me all kinds of problems because my spine has grown crooked and curved - its a mess and if I would've been adjusted as a baby and throughout childhood, it would've been corrected.

[k13]

You know--even with your history, I would not birth in a hospital. Your babies would have been put through so much more and likely a lot of needless treatments in the hospital, and some of those treatments could have caused more harm than good, leading to MORE time in the hospital. And your birth doc really won't have much say over what happens to baby once NICU staff get their hands on baby. Being home, even if it seems scary without all the hi tech gear, has distinct advantages for the baby whose beginning is stressful.

I agree - I had the opposite problem that both my babies were small and early, so I had issues related to them being undercooked. With the second we ended up going up to the hospital after the birth and it was a nightmare of mostly unnecessary and overzealous testing and monitoring in the NICU. I'm still glad I had both births at home. The hospital would have been way worse. I'm doing what I can to keep this one in to term to try and avoid any of my previous problems and being prepared to deal with potential problems at home, with the hospital as emergency back up.