HBAC ....hospital transfers?

[ann_of_loxley]

So I am trying to realistically figure out what would mean a hospital transfer when trying for HBAC....Theres the obvious uterin rupture or highly suspected UR.

Other things I can think of are:

• Placenta abruption
• Cord Prolapse

But what else do I need to be educated on/prepared for/etc?

I am sure everything will be fine - but if things go tits up, I want to still feel in control and I still want things to be as natural and peaceful as possible for my baby - so I feel I need to know of what could unlikely happen. I also don't want to feel 'tricked' into transfer if I didn't really need to iykwim.

Whats really serious?
Whats a real concern?
Whats most likely?

[TCA2008]

well....fetal distress - really low heartrate that doesn't seem to be coming up (and that could be caused by any number of difficult to predict reasons - tight cord wrapped multiple times around neck, uterine rupture, etc...)

maternal exhaustion - impossible to put a time limit on this, it really is going to be different for each woman, but if you have been laboring and/or pushing an extraordinarily long time and your body is just too worn out to continue, then a transfer can be appropriate, and does not mean you need a c-section. I've had a number of friends who transferred after 30-40 hours of labor, received some pain relief and rest at the hospital and then went on to vaginally push a baby out. Most homebirth transfers I know of are for this, or similarly because they have been pushing for many, many hours and the baby is not descending - again, I know some people who have transferred that after the use of a vacuum, or a little pitocin boost at the hospital, then go on to successfully vaginally deliver.

[mwherbs]

talk to a midwife-
it can be a long list- things like high bp- or ss of pre eclampsia, heavy bleeding, signs and symptoms of infection, presence of mec, mal position of the baby , heart rate too low or too high or late decelerations with low or slow recovery, heart rate that has trimmed it's self to steady like a metronome/no reaction of baby to outside stimuli- and the others that have been mentioned

[perditafoster]

I transferred with dd #2 due to maternal exhaustion. I rode to the hosp at 10 cm...oh so fun. Dd's heart rate was perfect throughout, so when we go to the hosp, I got an epidural, an IV with glucose, rested a bit, and went on to have a wonderful VBAC!!!! It was not very traumatic transferring; since her hr was fine, dh just drove me. I mean, I was yelling and in pain, but I wasn't scared that the baby was in distress or anything.

Fortunately, most situations that require transfer take a bit to develop, and an experienced mw will see the problem long before it becomes too big to manage. So transferring should be a calm, patient, not panicky ordeal. If you're riding on a baby's head at 10 cm, though, be prepared to be a bit uncomfortable!!!!!

[hikingmommy]

I think it's really important that your birth team understands the circumstances under which you'd consider transferring. I had an HBAC in April. It was a very difficult labor - quite long, extremely long second stage, big baby, lots of tearing, blood loss, etc. There were many factors that could have easily turned into a transfer if I'd had a less experienced MW or one who didn't evaluate each possible problem objectively to determine if it was something she could safely handle. I knew that if I transferred it'd end up being a repeat c-section, which would have killed me emotionally. I think with the other 2 MWs we interviewed I would have ended up transferring. This is a bit rambling. Sorry, I'm quite tired. My point goes back to the first sentence. It's important to have a MW (and other team members) who will respect your desire to stay home if at all possible and not bring up transfer unless it's truly necessary for your health or the baby's. Best wishes for a wonderful HBAC!

[smeisnotapirate]

ann!

[flapjack]

The circumstances under which you're likely to be advised to transfer are:

Unusual FHTs (first warning of abruption, rupture, etc.)
Prolonged ROM- for my trust, they want you in for administration of abx at 18 hours post-rupture.
Blood or meconium.
Malpositioning.
High maternal temperature (in particular, if you're planning on a water birth, do NOT get into the pool until the midwife is there, just in case you get the water temperature wrong.)
High maternal blood pressure.

Of those, I personally would only consider arguing with a recommended transfer for ROM or possibly a malposition- it would depend greatly upon the midwife. The chances are that you won't know what's causing any of these things at the time, though, which is one of the reasons why UK midwives are sometimes quicker to transfer than their US counterparts.
Remember, nobody can force you to do anything against your will. Even in a hospital, they cannot make you have another c-section, cannot make you do anything that you do not feel is in your best interests. You have the right to say no to anything that you do not believe is in your best interests. That puts a lot of pressure on you, to be sure that you're saying no for the right reasons, but you have that protection.

Have you talked to AIMS yet? That might help...

[ACsMom]

Different midwives seem to have different lists of circumstances under which they would advise transfer, so make sure to ask your midwife about this, then talk in more detail about each one. I'm going for an HBAC too, and had to change midwives in the middle of my pregnancy. My new mw has slightly different ideas about what she'd transfer for, so I've had to readjust my thinking a bit! For example, if your mw says she would recommend transfer for maternal high blood pressure, as her what she means by that. Some elevation in bp during late pregnancy and delivery is completely normal, not a sign of toxemia or any other problem.

Good luck to you and me!!