any L&D nurses have a homebirth?

[caedmyn]

This is kind of an odd question, but we're seriously considering have a homebirth without a midwife (because of not being able to find a midwife we're comfortable with), with a friend who is a L&D nurse there in case of emergency. Now obviously she isn't going to have the same training or preparation for out-of-hospital emergencies as a homebirth midwife. I'm trying to figure out about how different the things she's trained in/can do are from what a homebirth midwife would do (as far as the actual birth & afterwards...I'm not concerned about labor support or needing any assistance while laboring). My two main concerns are a baby that needed rescucitation, which I would think she would be able to handle until an ambulance got there, and being able to recognize a PPH. I would plan on having herbs available in case of PPH, and probably some basic rescucitation equipment for baby as well.

[Jenne]

She may be putting her butt on the line though if something winds up awry. I think most states would consider it "practicing medicine without a license" for you to be attended by a nurse who is not a licensed midwife or doctor. Has she talked about that aspect with you? I could be wrong...I'm sure others will weigh in. It would be too much for me to ask a friend to risk.

Jenne

[caedmyn]

She completely volunteered, I didn't ask her at all. I wouldn't ask her to accompany us to the hospital if something did go wrong, nor mention that she was at the birth.

[babycatcher12]

I am an L&D nurse and I'm planning a HBA3C. My comfort level would be practicing as a montrice and not a nurse. I would even have "good friends" sign a montrice contract so that I wouldn't lose my RN license. (And I have done this).

That being said...where I practice we have to have certification in neonatal resuscitation (NRP) which is what our HB midwife has. So the resuscitation of a baby should be okay. Although she'll need to consider she won't have the "bells and whistles" she has access to at the hospital, such as bag and mask, O2, meds etc. Will you have O2 available if needed?

And IMO any L&D nurse should be able to recognize a PPH. It's a pretty basic assessment.
My biggest concerns wouldn't be the ones you mentioned but here are a couple questions I would consider...

How long has she been practicing?

How comfortable/experienced is she in recognizing fetal distress (without a monitor)? Most L&D nurses have very little experience counting fetal heart rate or monitoring contractions without the monitor as it is "standard policy" in most hospitals. It is a skill that should be practiced and acquired with time.

Does she know how to relieve shoulder dystocia should it occur? How often does she/has she had the opportunity to "catch" a baby? (It's not as easy as it looks. ).

What will you do if you need a perineal repair?

I would also ask how comfortable is she with "natural childbirth". I know she knows what it is, but to be honest we see it so rarely in the hospital, that you kind of forget what it looks like. It can be unnerving to someone who isn't comfortable with it. YKWIM?

If you have to call an ambulance...what's your plan? Is she going to hide in the bathroom, who will tell the paramedics what has been going on? (I don't say this to be inflammatory, but it would be nice to have someone willing to be there and explain the course of labor thus far to those transferring).

FWIW...What she is "trained in/can do" are different things if she's there as a friend vs if she's there as a nurse. If she's attending the birth as a nurse who is a friend, but is still responsible for assessing you etc. she is practicing outside of her scope of practice.

I realize that she is a friend and she volunteered, but does that mean you're willing to abdicate her of all responsibility in regards to your safety and your baby's safety (meaning you won't sue her for neglience)? I'm not trying to play the "what if your baby dies card", but I'm simply trying to bring up a point to consider when having a friend be your health care provider. I guess what I'm getting at is you're essentially planning a UC, with an L&D nurse friend there...just in case, right?

I have been at the births of many of my friends and once or twice been there to "catch" the baby. But...we had a midwife "in house" so to speak should things go awry or we had a back up plan. I still had them sign a montrice contract to protect my license.

Good luck with your birth and I hope you can find a birth situation you are comfortable with.

[turnquia]

As a nurse (not L&D though) I wanted to chime in here.

I think your friend could potentially be butting her licence and career on the line in the event something goes wrong.

Even if she transfers with you she could be in deep with her boss and turned in for practicing without a license. Now if you come in for something like meconium in fluid that isn't as big of an issue, because she really wasn't DOING anything.

But if you transfer for a bigger issue like an issue with baby or a PP hemorrhage she is going to be thrown into the cross hairs. And legally she could face huge issues.

I'd love to go and be a CPM in my state, but it would require me to drop my nursing license. In order to be able to practice fully without prosecution due to how the laws here work.

I'd look into in your area and tred with caution. There is nothing wrong with her being there provided she isn't providing you medical care. Rubbing your back etc, getting you water. But the second she begins listening to heart tones, checking you etc she has overstepped her license.

[cileag]

This is a pretty tough situation--I agree with the issues that Babycatcher12 brought up. My SIL is due in August and we've talked about me being there for labor support and maybe a quick VE to assess when to head into the hospital, but I don't think I'd be comfortable being her "just in case" person. I would strongly suggest that you reconsider hiring a midwife if you feel like you need someone trained around. It's not just bells and whistles your friend will be missing---it's seriously necessary equipment such as an ambubag or pitocin---without which recognizing the need for resuscitation won't particularly help. Most people who have given birth before can recognize a PPH, but without Pitocin or methergine or cytotect, nursing and fundal massage can only do so much. I am confident that I know a lot--and that I can assist midwives and MDs really well and that with the majority of uncomplicated births, I'd be fine. However, you're asking her to step in when it becomes complicated and that's when you should have a midwife present, not a friend, even one with some relevant skills.

[caedmyn]

She really would be there just to observe and tell us if she thinks something is happening that's out-of-the-ordinary. I don't anticipate having her do any monitoring, VEs, etc. If baby needed rescucitation I would want her to do that. I would imagine we could get an ambubag or whatever those or called, probably oxygen as well. DH seems to think you can get pitocin from overseas online pharmacies but I'm not too sure about that.

I would really prefer to have a midwife there, but there are three in our area, one of which I strongly dislike, one of which I am not comfortable with any longer due to some honesty & possible competency issues, and the other is an apprentice who comes with a CNM who is more medical minded that we're happy with. DH refuses to hire the apprentice/CNM combo because he doesn't see the point in paying someone to tell us what we can't do (no waterbirths). I might be able to have a midwife who lives too far away to attend the birth be available for phone consultations during labor/birth.

Honestly I don't see how my friend could get in trouble unless we disclose that she was there, and I don't plan on doing that. I would think even if we called an ambulance she could tell what was going on if necessary without disclosing that she's a nurse. I suppose if there was a cord prolapse or something like that she might end up going to the hospital with us, but I wouldn't think there's be much of an issue with saying, "Oops, water broke at home, mom realized cord was hanging out, had to do something."

She's been a L&D nurse for 13 years. I was planning on getting one of those at-home Dopplers that displays the heartrate for use in labor. I'm really not too worried about shoulder dystocia, I think after two 7 lb babies it's pretty unlikely to be an issue. I know it's possible, but chances are probably pretty slim.

By catching the baby, do you mean just grabbing the baby as it comes out, or the head flexing thing that a lot of midwives do? I'm not planning on having anyone mess with the head, and DH caught our first so it doesn't seem like it's that complicated (assuming I'm not standing up I guess!).

I'd have to go to the hospital for sutures I guess, or see if the CNM would do it. That might be an issue as I have torn & had sutures with both my previous births.

I will have to make sure she understands that the birth would be hands off, no VEs, limited monitoring, don't mess with the baby unless they're obviously having problems, etc.

I do realize it would be a UC with her there. I don't feel like there are any other options.

What is a montrice, anyway?

[nikirj]

Different situation, but I did attend a birth where mom had invited an L&D nurse friend for support. She had a REALLY HARD time not jumping in and doing things that were part of her usual routine; quite a few times she started to do something and then paused, looked around, and did something more supportive and less medical. She did great IMO and was a wonderful person to have there, but it made me realize how those habits could seriously affect what she did at that birth if she wasn't so aware of them and consciously trying to do differently.

Long story short, I'd make sure your L&D nurse friend was going to be able to refrain from doing some of the standard delivery-room things (example - in many hospitals nurses do a pretty aggressive uterine/fundal massage shortly after birth).

I don't feel like you should take it on yourself to worry about her liability if she's willing to do this (beyond understanding that she may ask you to do/sign some things to protect herself). She's going to know way more than any of us what the climate/community is in your area and how far she's willing to go (or what she needs to do to feel comfortable).

[cileag]

Has she every been at a home birth before? That would be a key questions I would ask---like Nikirj said, there are huge differences and I know that even very natural friendly nurses where I work would still be uncomfortable with how a home birth progresses typically. Also, in the hospital, we resuscitate ALL babies---tactile stimulation and bulb syringe is virtually 100% and those are considered mild resuscitation. In my experience, home birth midwives are ok with babies that are pinking up more gradually and not crying very loudly versus in a hospital setting, the crying is emphasized to "clear out the lungs".

Of course, her individual temperment and experience plays a key role in this, but again, if you're looking for someone to be around for a "bad scenario", I would hire a midwife, even if they aren't the best fit.

She really would be there just to observe and tell us if she thinks something is happening that's out-of-the-ordinary.

This is actually quite a difficult and nuanced decision to make---and it usually requires those things you said you weren't going to have her do---monitoring an occasional temperature or BP, interpreting fetal heart rates, VE to assess for change or in the event of really prolonged labor, perhaps assessing for posterior or acynclitic presentation. Again, in a birth where things go smoothly, none of these things are really necessary, but it's the skill to make that judgement that a midwife has, is trained to give, and is comfortable making those calls.

[turnquia]

FYI if your friend is even there observing and says she thinks things are not going smoothly, she is still practicing outside of her license in some states. So just look into regulations for her.

VERY recently two lay persons, (family members of the person in labor) were attending a UC and were charged with practicing without a license. (IN the state of Florida) because of things that were done, and some of which quite neglectful... but even if your friend is helping out depending where you live it could be HUGEL, detrimental to her career and life.

You to me don't seem fully comfy with the idea of UC, and even with your friend there you are pretty much going to have to UC. So, I think you need to figure out what route fits you best, either a UC or having medical personel present. And if you choose having medical personal make sure its someone who can legally assist you without possible legal ramifications as well as loss of livelyhood. If you choose to UC great and even want your L&D friend there, awesome.. just make sure she knows her place is NOT to be assisting or providing ANY FORM of medical consultation. I think if you expect her to provide her medical advice its awefully risky on both your parts as well as hers, because jail time or permanent loss of her license could result.

[babycatcher12]

Quote:
She really would be there just to observe and tell us if she thinks something is happening that's out-of-the-ordinary.

This is actually quite a difficult and nuanced decision to make---and it usually requires those things you said you weren't going to have her do---monitoring an occasional temperature or BP, interpreting fetal heart rates, VE to assess for change or in the event of really prolonged labor, perhaps assessing for posterior or acynclitic presentation. Again, in a birth where things go smoothly, none of these things are really necessary, but it's the skill to make that judgment that a midwife has, is trained to give, and is comfortable making those calls.

I totally agree.

You to me don't seem fully comfy with the idea of UC, and even with your friend there you are pretty much going to have to UC. So, I think you need to figure out what route fits you best, either a UC or having medical personnel present. And if you choose having medical personal make sure its someone who can legally assist you without possible legal ramifications as well as loss of livelihood. If you choose to UC great and even want your L&D friend there, awesome.. just make sure she knows her place is NOT to be assisting or providing ANY FORM of medical consultation. I think if you expect her to provide her medical advice its awefully risky on both your parts as well as hers, because jail time or permanent loss of her license could result.

Agree!
Ultimately it's up to you...but YOU and your DH have to be comfortable with the idea of a UC. Asking your L&D friend to tell you if she thinks something is wrong is putting her in a difficult spot and risking her license. A montrice is someone who is kind of half way between a doula and midwife. She knows enough to check FHT, VE etc, and can give you her opinion, but isn't responsible for providing care for you or the baby. Meaning she doesn't resuscitate the baby, catch the baby or assist in your postpartum care in any way etc.

if you're looking for someone to be around for a "bad scenario", I would hire a midwife, even if they aren't the best fit.

Especially if you're asking her to not do some basic assessments (such as FHT, VE even minimal ones, etc). You have to assess to determine if there is "something" going wrong. I'm not saying she has to be invasive about it, but there are some things that someone will need to assess to determine if you need intervention. You and DH (and your friend) will need to decide who is going to be responsible for that assessment. If it's your friend, I think her license will be at risk.

Honestly I don't see how my friend could get in trouble unless we disclose that she was there, and I don't plan on doing that.

I'm assuming by you saying this that you are comfortable with not holding her responsible in the event that something does go wrong with either you or the baby even if it's clearly negligent on her part and you have a poor outcome? Also, that your community is large enough that no one will recognize her or know her should you need to transfer?

[caedmyn]

Originally Posted by babycatcher12

Especially if you're asking her to not do some basic assessments (such as FHT, VE even minimal ones, etc). You have to assess to determine if there is "something" going wrong. I'm not saying she has to be invasive about it, but there are some things that someone will need to assess to determine if you need intervention. You and DH (and your friend) will need to decide who is going to be responsible for that assessment. If it's your friend, I think her license will be at risk.



I'm assuming by you saying this that you are comfortable with not holding her responsible in the event that something does go wrong with either you or the baby even if it's clearly negligent on her part and you have a poor outcome? Also, that your community is large enough that no one will recognize her or know her should you need to transfer?

We would do FHT, BP checks, etc and give her the information but she wouldn't be doing them. She'd be there as an observer, but with the expectation that if she thinks something is wrong, she says something.

I am comfortable not holding her responsible. I guess I feel well-educated enough to be able to figure out if something is wrong and probably a reasonable course of action as well. But I don't feel comfortable rescitating a baby. I guess if something went drastically wrong there and she was clearly negligent I would probably blame her...but that wouldn't include sueing her or trying to cause her to loose her license. That's just not the way we work.

And if we transferred with her she would definitely be recognized, considering there's only one hospital in town and she works there. But again I wouldn't give her name out or expect her to transfer with us.

I just need to find a way to convince DH that a less-than-optimal homebirth with a midwife is better than any form of UC. I don't want to UC. I'm considering it with my friend there and I'd consider it alone (in a hotel within a few blocks from the hospital) if the choice were between that and a hospital birth, but it's not. It's a choice between a more medical minded midwife (which might not be an issue anyway, as far as I'm concerned if I want to have a waterbirth she can stay upstairs and I'll call her after baby is out as long as everything is going smoothly) or possibly a homebirth 3 hours away at my parents' house. DH doesn't see the point in paying for anything less than an optimal situation.

[BeanSprout Mama]

Originally Posted by caedmyn

She really would be there just to observe and tell us if she thinks something is happening that's out-of-the-ordinary. I don't anticipate having her do any monitoring, VEs, etc. If baby needed rescucitation I would want her to do that.

I'm a L&D nurse and my jaw literally dropped when I saw your post. I am in shock that your friend would offer to do this. Even if she is "only" there to tell you if something is out of the ordinary, that comes extremely close to making medical diagnoses and practicing medicine without a license. She's going way, WAY beyond her licensed scope of practice and is potentially throwing away her license. It's really, really unwise and as her friend I think you have the responsibility to say that you appreciate her offer but that you care too much about her to allow her to risk her livelihood for your sake.

ETA: Also, it doesn't even matter if something goes wrong in terms of whether it's okay for her to attend your birth alone. If she mentions it to the wrong person, or if you do and that person can figure out who she is, then that person can report her to the board of nursing and she'll be investigated for going outside of her scope of practice/practicing medicine without a license. If you care about her you cannot allow her to do this for you.

[kitkatkaddoodle]

I've been an L&D nurse for 12 years; I had an (unplanned) unattended homebirth last month, and my first birth was an attempted homebirth turned transfer for decels and mec (he had a true knot and nucal x2 that tightened on decent). Both deliveries were unmedicated and very little intervention--okay, the last one had NO interventions since I had about 30 minutes of thinking I might be really in labor before she popped out.

I'm afraid there's no way in hell I'd be 'back-up' to someone with secondhand information. Your friend might agree, but fetal heart tones especially are not something I trust people to report to me if I am the person making the call to say it's an emergency or not--I need to hear/see it myself.

I hope you find a way to have the birth you want.

[alicia9178]

Originally Posted by Jenne

She may be putting her butt on the line though if something winds up awry. I think most states would consider it "practicing medicine without a license" for you to be attended by a nurse who is not a licensed midwife or doctor.

Yes....she is risking her license for reasons that you stated.

[alicia9178]

I am an ER RN, and I am planning a homebirth with my husband in Feb and we are going to have a midwife there as a resource to us while I am in labor. I would LOVE to be able to assist any friend with their birth as I have worked in L&D and I am a doula.....HOWEVER...I would ONLY do it with a signed contract that stated I was there for labor support as a doula...and I would not offer medical advise because as a RN you cannot diagnose nor can you treat without MD orders. You might think that if something happens you would not "tell on" your friend, but in a crisis she is going to stand by your side and not hide in a bathroom...and trust me when stuff goes down related to a homebirth...especially depending on where you live there will be no hiding who was there and she will be held accountable based upon being a licensed individual. It is sad, but it is a HUGE risk.

[honeybee]

I would just say that if YOU are not comfortable with a UC, then you should not have a UC, whether there is someone with some experience there or not. Just as a dh should not determine whether a woman should have a homebirth or not, he should not be the deciding factor on who attends. You have to be comfortable. If you are more comfortable with a less-than-ideal fit in order to have someone skilled in doing resuscitation and noticing a pph, then that is what you should do.

I would question how much experience a L&D nurse would have in infant resuscitation, actually. In a hospital, you would have the OB and the neonatal specialists on hand, so I wouldn't think the nurse would be doing much hands-on, even if she had the training? Maybe it's different in smaller hospitals, though. Of course, there are hb midwives that need to actually do it only very infrequently, too, and just keep up their certification with training, so that might be a moot point.

I would worry about repercussions for your friend, too.