What to expect if delivery is by going through the ER and having a c-section?

[Noelle C.]

This isn't what I want, but it's a possibility of what may happen. Long story short, insurance is making our home birth pretty much impossible, won't cover what their policy states, this baby isn't head-down, and we can't afford to pay out-of-pocket for what's needed to try turning her since all that money's going to insurance premiums for nothing to be covered. I'm already against the odds in a pregnancy lasting this long (longer story I won't get into), and I have a midwife, not an OB/GYN, so no head-down baby means it's illegal for the midwife to be around.

Since I technically could go into labor any time now (even though I'm just shy of 36 weeks), we have to now look at all possibilities. Since I have no OB/GYN, if this baby stay transverse or goes back full breech, I'll have to go to the ER. Since I have an extensive medical history, I can say hello to a c-section. No doctor would allow an attempt at a vaginal breech birth for someone with a medical history who he/she has never met before. All the risks aside (for me, a 50% of the worst outcome, which I've accepted at this point as possible, though it doesn't make me happy)...

...what happens when you go into an ER in labor and it's going to be a c-section? Especially when it's an ER at a hospital you've never been to. What do you do? When you walk in and tell them you're in labor what happens? Do you have to wait in the waiting room or do the hurry you through triage and get you on a bed in the back? Is it any faster to get to see a doctor than waiting, or is labor considered a level 3 or 4 triage and you can wait like everyone else? What can be expected when you do get to see a doctor and you explain quickly your medical history? Would they put me under general or would my fiance get to be there? If I could die (50% chance) I don't want to go under general. I want him there with me.

In my experience with ERs, it can be a long wait, even when you're dying (I once sat in the waiting room for, I swear, ten full hours with a tear in my intestine and my abdomen visibly swelling and a high fever from it). I suppose, if the baby goes breech, this could work in my favor because maybe she'd get to be born on her own vaginally while waiting. If she's transverse, she can't come out, so then what?

I know, I KNOW, this sounds stupid, but I don't have the luxury of not considering the worst scenario any of us would want to fathom for delivery. We don't have the money to have many other options at this point, nor do we have the time to consider much else. I've accepted I've got a higher chance of not living, and I'm getting to the point of apathetic thanks to being tired of life and just wanting it to be over already. I just don't know what else to expect. The unknown is what scares me, not death, just not knowing what to expect.

So I guess the long questions short is:

What should I expect if delivery ends up being via c-section in an ER I've never been to?

[SeekingJoy]

I have no idea, but here is a bump and a . I am so sorry you are in this situation.

[annekh23]

I'd check out if you would really have to go in via the ER, given this is a situation you know you could be in, you should at least pick the hospital and try and find out if there is a way to bypass the ER. I know that at our local hospital the rule is that any pregnant mum beyond 20 weeks who comes in with abdominal pain goes straight to labour and delivery and I do mean straight, you'd go to the desk say you think you're in labour and the receptionist would have the nearest person grab a wheelchair and take you up there. Which would probably mean you'd go through obstetric triage if they have that.

It's worth figuring out what would happen if you called labour and delivery and said you were coming in, or what would happen if you showed up at the door and so on.

[Jane]

Can your midwife transfer you in? In such situations, they usually let us bypass the ER and go directly to L&D.
I would hope your insurance would pay for a breech version. Can you transfer to a Ob as long as your baby stays breech?
On the cheap end, moxabustion is dirt cheap. You just burn the sticks and hold them near your pinky toe. They make baby move a ton and gravity does the rest. Baby's head is heavy and tends to pull baby into vertex. If you can get baby transverse, it should be an easy switch for an experienced doctor to put baby vertex.

If you end up in the ER - they'll punt your upstairs to L&D ASAP. They do not like the preggos in their care at all, no equipment, no desire to catch, lack of familiarity with complications.

[Honey693]

My OB told me if i had a problem and went to the hospital before I called her to not go to the ER. She said just go straight to L&D and the L&D nurses told me the same thing.

[JamieCatheryn]

At the hospital I delivered at they sent me directly to L&D after a few minutes of paperwork. Or if you go in by ambulance they'll wheel you straight there. No ER. Can you pre register so they have your medical history? They ask a lot of questions and think you can just answer while you labor, it's insane really. I tuned them out and told them talk to DH.

How much does an attempted manual turning cost? And have you checked with a chiro about OOP cost for webster? Many are willing to cut you a break if you're in need. Try everything spinningbabies.com suggests as far as positions before labor or in early labor. Of course breech UC can be done so long as it's not transverse, Laura Shanley and many others have done it, but that has to really feel right to go for that and I guess your intuition is saying that isn't for you.

[etsdtm99]

like everyone else has pretty mcuh said - at my hospital if you're pregnant past 20 weeks you go to L&D and go through their triage, not the ER .. it can still be a bit of a wait but nothing like the ER..

[JollyGG]

I don't know how it works in all ERs, but I can tell you how what the policy was in the one ER I worked in. All pregnant and laboring women were sent straight up to the maternity floor. They had the tech (me at the time) grab a wheel chair and called to let maternity know the mom was on the way up. They didn't triage them, examine them, or really touch them in any way shape or form just sent them straight up to the maternity floor.

I have a friend whose pregnant right now. She has some concerns as the hospital she plans to deliver at does evidentialy keep maternity patients in the ER for a little bit before sending them up. You have to go in through the ER after certain hours of the day. When you come in through ER they said their policy was to monitor the mother for an hour or so to be sure labor was actually established before sending moms up to the maternity floor.

So I think that what you can expect probably depends on the individual hospital. I'd just call and ask.

[Jenivere]

I had my first at a hospital and we entered through the ER. They asked me a couple of questions like how long have you been having contractions and when are you due then sent me straight up to L&D. I really doubt they'd keep you waiting in the ER.

[Super~Single~Mama]

I'll just agree with pp's and say that if you go to the hospital you're likely to be put in a wheelchair and taken to L&D right away. I went in twice when I was pregnant to the hospital and I just had to wait for someone to get a wheelchair - I didn't even speak with anyone at the ER.

[khaoskat]

Normally they send you straight to L&D. My old midwife, had a patient come in via ambulance I believe. She met them at the doors of the ER, and delivered the baby right there.

I have never seen fetal monitoring equipment in the ER rooms, but that doesn't mean that they don't have a mobile telemetry unit or two floating about.

As for turning the baby. My DD2 was transverse until the day she was born. While I was sleeping she turned heads up, which my OB was comfortable with. What I did was elevate my hips, and put an ice pack at the place where her head was and a hot pack down at my pelvis. When I elevated my hips, I made sure they were at least 18-24 inches above my heart. It is sometimes recommended to use like an ironing board on the bottom stairs (this way it does not slide down) and then lay down on it for 10-20 minutes at a time.

Check out www.spinningbabies.com it has some excellent information.

Not sure what your health history is, but if they are not familiar with your history as to why there is a 50/50 chance, good chances are that if you are but first breech, by the time they get everything established you could be pushing the baby out vaginally. Some larger hospitals, especially teaching hospitals, have OB's who are trained in breech birth and are often times willing to do them.

Good luck.

[mamatolevi]

I am surprised your mw isn't willing to try a version. Given that, I'd be calling an ob on your ins plan and having a visit with them - at least then you've met someone who has a copy of your history on file. I imagine that if the baby is a stubborn transverse most OBs would be fine with taking you late and scheduling a c/s for transverse breech. (they get the whole global fee for only doing an appt or two + surgery) Their surgical coordinator in the OB's office should be able to iron out any problems with the ins company.

If you do decide that you need to try for your HB and then feel a transfer is necessary, going in saying "I'm in labor and the baby is TRANSVERSE!" should get you to the head of the line pretty quickly. It wouldn't hurt to make yourself familiar with the hosptial's polcies. There's absolutely no harm in calling them. Ask to speak to L&D and ask questions of the nurses or even the charge nurse. Take the tour. You may get a little flack for trying HB (depending on the birthing climate where you live), but you also may be able to pre-register so that your history is available if you show up.

I said this in another thread... You need to contact your state insurance commissioner rgarding the ins. co refusing to provide coverage stated in the policy. I know it's a huge hassle but from what you've said it sounds necessary.

[Noelle C.]

Our midwife is going to try a version next Wednesday.

The insurance commissioner has been notified. We aren't the only people who've filed complaints and grievances about this insurance company. They've been sued many times and have yet to win a lawsuit. They keep losing.

We met with one doctor who currently can't take patients who are transverse or breech because, well he technically can, but the problem is he won't force a woman into a c-section, and one more breech birth and his hospital privileges are gone. The hospitals here are so adamantly against breech vaginals that he's been told one more and he's out. He's already under review and might lose his privileges as it is. He hates having to compromise his morals to keep his privileges (I think I said license in another thread - I mean privileges), so, for the time being, is having to be careful.

I've had no luck finding a doctor who will take me on as an actual patient with my medical history and how I'm already "term" as far as bicornuate moms go. No, this doesn't mean it's good to go cut a baby out, just that it's not usual for moms with my uterine condition (nevermine the intestinal stuff) to go so long. A cousin of mine has the same bicornuate condition and her c-section is scheduled already for her 32nd week. Monday willl be another day of searching.

Okay, so let's say they would send me right to L&D. Then what? When someone has a medical history, and the baby isn't head-down (if she was head-down, we'd deliver at home, no question about it), it's c-section. When the doctor hasn't met the patient and labor's already started and policy is a c-section, what happens then?

[MeepyCat]

It's definitely my experience that, if you're pregnant, the ER will kick you up to L&D. If the hospital in question doesn't have an L&D unit or appropriate NICU facilities, they may try to transfer you by ambulance - you definitely want to pick your ER if that's the route you're going.

If the situation isn't an emergency, you can expect to spend some time in L&D triage. They'll ask if you were seeing someone somewhere else, and do what they can to get your records. If you were seeing a midwife, it would be handy to bring a copy of your records with you (or, if possible, have the midwife as a doula and bring her).

Expect some monitoring. Expect to explain the salient details of your medical history to the doctors and nurses. Expect that you may have to explain it a couple times. They'll want to type your blood (even if the info is in your records). They'll check with you about your due date, and what care you've already had. They'll want to check your cervix.

If they're going to do a c-section, they will send in an anesthesiologist to talk with you. The ana will discuss risks with you and ask you to sign a consent form. They'll want to know when you last ate. Since spinal anesthesia has fewer risks than general, they usually try to do that, but spinal anesthesia can cause your blood pressure to drop. If they're concerned about your BP being too low, they'll go for general anesthesia.

Most hospitals have policies allowing partners, spouses or support people to accompany patients to the ER for c-section. Definitely check into policies at the local hospitals.

At some point, you'll see an attending physician on the floor. S/he will discuss things like what happens next, and when they want to operate.

Good luck.

[Sijae]

I don't know what your medical issue is that would make a cesarean more dangerous for you but if I believed that I had a 50% chance of dying from a c-section, I would have a vaginal breech unassisted at home before I stepped into that hospital. Statistically, you have a much greater chance of a good outcome for you and baby with that choice then the one you outlined.

Cesareans are always 4 times more dangerous for the mom than vaginal birth without any complicating factors. And for full-term babies the outcomes of breech birth are the same for vaginal vs. cesarean. People assume that cesarean eliminates the extra risk for breech delivery but it's not true; a cesarean breech is more risky than a cesarean vertex.

If I had made the decision to have the cesarean, I'd be down at the hospital registering and talking to an OB about a planned cesarean to reduce the "emergency" aspect of it.

[annekh23]

Seems like one of the problems here is finding a doctor, not just finding a doctor that you like, but finding a doctor at all. I had the same problem, I went with midwives, needed a c-section and there back up for some reason didn't work out, just never returned any phone calls, in the end we had a doctor friend of ours speak personally to their OB and ask her to take me on, the personal referral, particularly from a doctor was what swung it, but we did nearly get in with another doctor, again via personal referral, but he was already on holiday around my due date. So I'd try using the less direct methods of getting in with a doctor, do you have a primary care doctor? If so, talk to them, moan at them etc. chances are they'll know an OB they can call in a favour from. Use friends, have them call their doctors. Call L&D, tell them you don't have a doctor and you'll be coming to them, ask them what you should do. Good Luck.

[mamatolevi]

Glad to hear that the mw is going to try a version! I hope it works and you get a great home birth!

If you transfer to the hospital for a c/s you'll get whoever is on call and willing to do a surgery.

That being said, I believe strongly in having a contingency plan, so here goes: Have your intestinal issue written on a single sheet of paper that can be handed to the dr/nurse/intake person. Mark it "LIFE AND DEATH INFORMATION." (a bit dramatic I know but it gets the point across that this is important) Have several copies to hand out to each person you talk to. Sometimes in a rush, the nurses and drs don't get to pass on all information and this makes sure they are aware of it. Inlcude any contact information for your regular dr in case they need to speak to someone before performing the surgery.

Given your history, I'd pre-register at the hospital. Have you considered contacting the hospital to speak with the chief of obstetrics or L&D nurse manager to at least find out how they would handle your situation? The recommendations above about using your dr to get a personal referral to an OB are good.

[nutritionistmom]

Homeopathic Pulsatilla 200 CH has a good results at getting babies to turn head down. I was able to turn my full breech at 35 wks with homeopathy. It's inexpensive and worth a try IMO.

[Sk8ermaiden]

I transferred to an unknown hospital with my midwives after being dilated to 10 and pushing for 6 hours.

We sat in the ER for about 2-3 minutes and then with contractions 1 minute apart they expected me to answer really stupid questions for about 5 minutes. This included, "And you're in active labor?" about 5 times.

Then they wheeled me up to L&D and into a room. Even though they were handed my extensive and meticulously detailed chart from my (legal) midwife, they apparently felt the need to draw blood and have it processed before they would do anything. So even though they had my medical history, they pretended like I was unknown.

Then I was told my only option was a c-section. Since it wasn't a "crash" section, I had a spinal and then my DH was allowed to come in.

If I were you, I would pre-register, just in case.

[rhiandmoi]

I don't know the details of your bicornate, but I would not be very optimistic about a version with a bicornate uterus, the septum just doesn't yield that well. And the version can really irritate the uterus.