Thinking about it

[BirdMum]

Hello.

Brief rundown on me is that I currently have a three year old DS (delivered in hospital by midwives and daddy) and am 25 weeks with our second.

Where I now live, we do not have *any* midwives (private or public) but what we do have is a terribly old fashioned approach to obstetric care.

I love my OB but I hate his practice and its policies. It is ridiculously old fashioned and unfriendly to natural parents. They also take a "sit down, shut up and do as you're told" approach to everything. Like many of you ladies, I am extremely educated about pregnancy, birth, and postpartum and I am vocal, so this does not work with me.

Ugh - this is a rant I could go on for a while. Like me, my husband is big into non-intervention birthing care. I'd planned to labour at home and hit the hospital when nearly ready to push. But they keep you a minimum of 24 hours here and I really, REALLY do not want to stay in the hospital with a new baby. With DS, I was at the hospital for 7 hours total (4 hours after birth - took the time to shower, go over PP care, learn how to latch him, and then we went home and my MW did follow ups at home.) My husband suggested homebirthing, and the idea has grown on me.

While my birth with DS was essentially unremarkable, I did have mild placenta accreta and had a 2" retained placental fragment for 7 weeks which had to be removed by D&C and caused some decent scarring. It is likely to happen again, and is often worse when it reoccurs. It could lead to haemorrhage. There is really no way to assess it prior to birthing the placenta. However, it also poses no risk until the placenta is delivered.

I do know already that my placenta is completely on the opposite side of my uterus this time.

So I'm really up in the air. If it weren't for the likelihood of the accreta reoccuring, I'd just... stop going to see my OB at 37 weeks. As we have no midwives, the birth would be unassisted.

I'm just wondering your ladies' thoughts. Is the risk just too great to birth at home without an attendant? Worth noting, we live about 5km from the hospital.

[zoebird]

well, i can't say what the risk factors are or if they are too much for you, etc.

looking up what the condition is, there is variability on the severity, and this increases the risks from something that can be managed by transfer vs something that must be handled by c-section and hysterectomy.

so, you have to determine for yourself what the real risk is in your own feeling/mind/body.

assuming it is likely to be the lighter version, it seems to me that you could birth at home and then head out to the hospital for transfer if the placenta does not come out when you expect it to (you can choose when this is). you then transfer to get treatment for retained placenta and whatever is related to that.

in such an instance, i would ahve DH stay with the children, have a friend join me at the hospital, and give that friend durable power of attorney to make decisions while i am in the hospital. i would speak with this person at length about what medical care i want and prefer, and so on.

then, when i felt ready to leave the hospital, i would leave AMA if i had to, and head back home to the baby moon.

that's just me, though. if i had this condition, i might be more considered in various ways, but really only you have the full picture of what is going on with you.

good luck with your decision!

[Illiana]

I agree with PP. I'd stay home and IF you have a problem then go in after the birth leaving baby at home and get the care you need and then sign out AMA if they're refusing to let you leave after the problem is taken care of.

[kittywitty]

Originally Posted by zoebird

assuming it is likely to be the lighter version, it seems to me that you could birth at home and then head out to the hospital for transfer if the placenta does not come out when you expect it to (you can choose when this is). you then transfer to get treatment for retained placenta and whatever is related to that.

I agree with zoebird. I would also recommend searching around for a midwife or birthing center even a little further away from you if the hospital is that bad.

[BirdMum]

Originally Posted by kittywitty

I agree with zoebird. I would also recommend searching around for a midwife or birthing center even a little further away from you if the hospital is that bad.

There's honestly none here, not in the province. I live in PEI - we're a very tiny province with very limited resources. We also have no way to pay a private midwife, even if we could find one willing to travel from New Brunswick (where they aren't regulated.)

My main concern isn't so much that I wouldn't be able to cope with an emergency should it happen - it's that my husband wouldn't be able to. We don't have anyone who would be open to being here, so it likely would just be us.

[zoebird]

well, here's the way i see it.

so often, our culture sees men as rather weak doofuses. but men are MEN right? so, the role is actually to be able to handle just about everything, and not be in the way. not panic, not freak out, but just do what needs to be done.

i hold this to be true. and as it is true, i notice a LOT of men--including my husband--tend to live up to it.

so, if you believe that he can live up to it, then he likely will believe it himself.

[EllyMayMomma]

Originally Posted by Illiana

I agree with PP. I'd stay home and IF you have a problem then go in after the birth leaving baby at home and get the care you need and then sign out AMA if they're refusing to let you leave after the problem is taken care of.

Just want to stress the "leaving the baby at home" part. Would be really hard to do but here the hospital would try VERY hard to admit the baby even if he was just fine, which could be a real mess.

[basje]

I think it totally depends on what you're comfortable with. March of Dimes website says that most women discover they have it via ultrasound so I would research when the best time during the pregnancy was to detect such a thing and opt for an ultrasound. I don't think that I would mention that's what I was looking for though to try and keep the tech a little more objective. Premature delivery and third trimester bleeding are also indicators, and where with a normal pregnancy I would be fine delivering anytime after 35 weeks, if I had your medical history I would likely go to hospital if I was more that two weeks early. But that's what I would do if I was you. You might do something different.

I did have problems after my UC with a retained placenta, which eventually came out, then major hemorrhage, and had a D&C which they had thought would explain all that bleeding. Turns out it was some freak thing and my D&C was clean (they did three just to make sure) but I pretty much bled out on the table. So having had it happen, I agree with Zoebird, I left the baby at home and went to the hospital with my doula who I had pre-prepared documentation giving her rights to act as my medical proxy and informed about my wishes in case of complications. I credit this move with my ability to breastfeed! My doula insisted that after getting out of my 5 hour D&C turned exploratory surgery that the lactation consultant be sent to the ICU to pump me. Not standard procedure, and saved my milk supply while I spent three days on a ventilator. Also helpful was having the number for a local MDC mom who came and nursed my baby while I was in hospital. Some of the super prepared things I did for my UC really ended working out when a few less than ideal things were thrown my way! Thankfully having an awesome birth and healthy baby made it was easier to deal with my own health complications afterward.

Another option would be to UC the birth then automatically transfer for the placenta, then either stay an hour after the bleeding stops to ensure you're not going to hemorrhage then leave against medical advice.

Never heard of this condition before, very interesting.

[BirdMum]

Thank you ladies, for your input. I've been encountering some issues lately that lead me to believe I may not go term with this pregnancy, and my OB is similarly concerned. As it is, I am now on partial bedrest as I've started contracting frequently and they start getting regular with any activity. The goal now is to just get as far into this pregnancy as I can, and I certainly wouldn't try to birth a preemie at home.

Should I make it to term, we're still deciding whether UC would be the way to go but are leaning that way. My husband is certainly up for it, though it would have to be an "accidental" UC. Having recently been in my local hospital's L&D ward, I have to say the thought of birthing there terrifies me. Hideous place. "Baby factory" comes to mind.

Basje - it isn't always possible to see accreta on ultrasound. I'd had one at ~35w with my son due to some growth concerns, and they did not catch it. I am thinking of requesting one late in the pregnancy to see if it is a concern this time.