How far is too far?

[John'sMama]

I'm planning an HBAC in May, but we live 40 min from a hospital that can handle an emergency during childbirth, if necessary. Ironically we live right next door to a hospital, but they haven't done labor/delivery for 20 years. I always read the "30 minutes from decision to incision" rule--how strict is that? If there's an emergency am I too far from a hospital?

[kathan12904]

It wouldn't deter me. The chances of a true emergency requiring immedeate medical attention are extremely rare in a healthy well monitored homebirth. UR is incredibly rare despite all the hoopla about it and in a natural labor, when mom can actually feel her body, it is even rarer to go undetected. As far as most other emergencies, there isn't any reason that the smaller, closer hospital couldn't stabilize you at least. The most devastating problem in any emergency is usually blood loss and that smaller hospital should at least be able to give saline or do a transfusion while getting you any help. Remember though, that these things are absolute worse case scenarios, which are very unlikely to occur. Ultimately, you have to make a decision that you are comfortable with and weigh that costs and benefits of staying home versus going to the hospital.

[SuzyLee]

Couldn't the hospital next to you handle a true emergency? If you came screaming into the ER I bet the ER doc could dig from the back of his brain the training he had in med school.

[John'sMama]

Yes, I'm sure the hospital in town could handle an emergency I might have, but I worry if there was an emergency with the baby they couldn't help with that (ie an emergency cesarean). It's better than nothing and isn't deterring me from desiring an HBAC, but I'm trying to calm my fears!

[rlmueller]

I think

If I were worried that much about it. I'd voice fears to midwife and MAYBE more liberal with need to transfer if it came up in the interest of time.

[kcparker]

I think I'd feel okay with a knowledgeable HB MW and a hospital with an ED that is very close by. Most problems with HB come on slowly enough that there is time to spot them coming with regular monitoring, and if the hospital is 40 min. with a regular speed limit, is it maybe 30 if the EMTs have their sirens on and they floor the accelerator?

I suppose there's also the option to find a hotel that is within a few minutes of the hospital that can handle emergencies and get a room there when you go into labor...

[JennTheMomma]

I would ask your Midwife what she is comfortable with. Some Midwives have a 20 minute from a hospital rule.

[CorasMama]

if the hospital is 40 minutes away, that's basically a one hour "decision to incision" in the best case scenario. They have to get you into the hospital, up to the OR, anaesthetized, and THEN incision, plus all the, you know, giving them information!

Is there a free-standing birth center closer to a hospital that's equipped to do births? What about a friend's house?

It really sounds like your hospital that is close is really NOT equipped to handle an emergency birth transfer, at least not as safely as I'd be comfortable with.

Since you asked, this would be outside my comfort zone for myself and my baby. I'm not having a hbac, but I'm using a fsbc because it is close to a good hospital, and my house's closest hospital (by a 10- to 15-minute margin) is HORRIBLE. They do births, but I don't trust them, especially in an emergency situation.

YMMV!

[Lineymom]

I am having a HB with the closest hospital 30 min away. My midwife is not concerned. I think the law in my state is 50 miles or minutes to the hospital. I am not dwelling on worst case senarios right now as I am due in just over two weeks, but back when I was, my biggest fear was not not making it to the hospital but them not acting fast enough when I got there.

[soveryblessed]

I'm 45 minutes (not speeding, regular traffic) from the closest hospital, which also happens to be the one that does births. I'm sure my DH could get us there faster if need be since the EMT's here are slow and don't always respond. This will be a HBAC for me too; I have had a VBAC before that was induced in the hospital, so I'm pretty confident that my uterus won't rupture this go around (they actually felt the inside of my scar and it was perfectly fine after my last birth).
I think you should do what your gut tells you. I'm terrified of hospitals, and even more upset that they have all these strict rules because of the H1N1 thing, so for me it's worth it to have a homebirth, even if it is a little further than I'd like. I wish we had the option of a birth center around here too!

[John'sMama]

I wish we had a free standing birth center, but IL has none. The closest is in WI & it's 4 hours away! I did still consider it but they wont take HBACs. I've actually thought about giving birth at my parent's house; they live about 7 hrs away but I figured I could just go there a week or so before my due date & my dh could come when it's time. They're just 15 min from a hospital. BUT, I'm not sure I'd want to take that 7 hour drive home any time soon after the birth! It's an option, at least.

[smeisnotapirate]

I would be perfectly comfortable. When I had to transfer (from birth center) for DS's birth, we drove 45 minutes to the hospital I wanted (as opposed to St.Slice-and-Dice Hospital nearby). We had plenty of time, as I labored for another 9 hours at THAT hospital before DS was born by c-section.

Keep in mind that most transfers are not emergent transfers. You have plenty of time.

[momonthebeach]

I had my youngest two at my house 1.5 hours from a hospital equipped to do c-sections. We had plans to transfer earlier than they normally would if complications seemed to be coming up. Both were born at home. I would discuss your concerns with your midwife. Any concerns I had were always resolved in a conversation with them!!
Katie

[John'sMama]

Thank you for all of your thoughts--it's great to have support! I tend to be a worrier, and try to figure out the "worst-case" scenarios first, then I feel better. I have my first mw appt in Dec so I'll chat with her then!

[witchypants]

I just moved from 5mins from a hospital to 30mins and was worried this would risk me out of a homebirth so I'm glad I found this thread!

[Spirit Dancer]

LOL. Wrong forum!!

[HappyMommy2]

40 minutes would not deter me. A couple hours wouldn't deter me now! I had an HBAC too.

If you have fears, bring your DH to the mw appt, and ask every "what if" question you can think of. Ask about worst case scenarios and various possibilities and what her response would be. That made my DH and my Mom TOTALLY on board with the situation.

[John'sMama]

I like that idea, HappyMommy2. We haven't told our families about our decision to hbac, and I don't think the idea will be well received. Now if I could only get everyone else who will think it's a bad idea to come to an appt We live in a small, rural town...I'm thinking the idea of homebirthing will seem like quite a bad idea to many! But, we're confident with it!

[CEG]

I would contact the hospital and ask them if they have 24 hour OB coverage. If they don't (I used to work in one of these) it can be an hour + to get an OR team in place. So if your MW has a good relationship with the hospital and calls to let them know that a section is necessary (and they are willing to set it up on her word) there may really be no delay in care at all.

I would be a bit leery of the hosp with no OB- they will also not have nicu equipment, neonatal rescisitation team, etc that may be needed in an emergency. Also there may or may not be a surgeon there when you arrive and there may be a delay in getting them there.

[HappyMommy2]

Originally Posted by John'sMama

I like that idea, HappyMommy2. We haven't told our families about our decision to hbac, and I don't think the idea will be well received. Now if I could only get everyone else who will think it's a bad idea to come to an appt We live in a small, rural town...I'm thinking the idea of homebirthing will seem like quite a bad idea to many! But, we're confident with it!

That's why I only told a couple people beforehand. Two close HB'ing girlfriends and my Mom. No in-laws, for sure! My DH had a great time making the announcement afterwards! :-)