Placenta abruption/cord prolapse/infection

[lovebeingamomma]

These are the three things on my mind when it comes to the safety of homebirth. If you have some insight on these things please share. How early can a midwife detect these problems? If they happened in the hospital (the first two), how fast can they do a c-section from when they notice the problem? If baby is infected, is there a time period in which the baby will suddenly die from it without antibiotics? Any more info...thanks.

[homebirthing]

Those are really great questions to ask at interviews!!

Placental abruption: You will either bleed or you won't. You will either feel it, or you won't. This can happen at any point and is rare and serious. It can happen before a midwife were to ever get there/you go to a hospital for a hospital birth. This is a call 911.

Cord prolapse: Often when the waters release. This could be from not in labor yet to at any point during labor. There is no warning. Your midwife could not be there. You could be shopping. The is rare and serious. This is a call 911.

Random infection: I am not sure what the baby is being infected by, however call 911 and go to the children's hospital. Or drive in to the hospital. Your midwife will know life saving procedures if needed.

[MyFullHouse]

It's also going to depend on your area hospitals.
I've been told that my hospital is a minimum of 30 minutes to set up the OR in the middle of the night. They're only fully staffed during the day.

[BlackSheepPDX]

I believe a cord prolapse is going to be visually/palpably detected in conjunction with possibly noting decels/problems on fetal monitoring. The treatment for cord prolapse is to elevate the hips if possible to avoid increased pressure on the cord and 911 transport. If noted, whether in hospital or not, and addressed (reducing pressure ASAP) I don't think there's a difference in being monitored by a midwife or being in the hospital under monitoring.

I think with all of these questions, and when deciding about homebirth, an important consideration is your transport plan/distance. While yes, complications of grave nature are RARE, it doesn't mean you shouldn't consider and plan for them as best as you can. In my own case, our home is a closer transport to our preferred hospital than the birthing center we would have had as an alternative to homebirth, and is really about 5 minutes. If I were in a setting where definitive care was an hour away, I'd be concerned, but at the same time, you have issues just going into labor that far away from care if you're PLANNING to go to the hospital, so there are always things to weigh.

[lovebeingamomma]

thanks everyone very helpful!

[honeybee]

One thing that helped me visualize this is reading and hearing accounts of birth stories from the midwife's perspective. One book that has two different chord prolapse scenarios is The Baby Catcher. The bad outcome one was not even a planned homebirth, but the mw acting as a doula got sucked into the situation. The mw did all she could... EMS and an OB (or may have been the ped's call, can't remember), made the situation much, much worse. In the second situation, she was a mw for a planned hb, they handled things well, and at the hospital the mw/docs/mother worked as a team and baby was healthy after an emergency c-section. Basically, in both cases the mw elevated mom's hips and physically held the baby's head off the chord with her fingers/hand during transport.

How fast any emergency can be dealt with is going to depend on a lot of different factors. Some hospitals do not have round-the-clock surgical teams on site... and they need to be called in. A large hospital may have more immediate access, but if they are understaffed, could have less hands-on monitoring so a problem might go undetected longer. Or, you might be just in the right place where a problem is detected immediately and they are able to wisk you in immediately. And then there is the factor of transport time from home to the hospital plays a role.

I know there are situations where a case could be made that a baby died at home who might have been saved in the hospital. I know there are situations where a case could be made that a baby (or mother!) died at the hospital who might have been born healthy at home (due to an unnecessary c, surgical error, a hospital mega-virus, etc.). I think both situations are extremely rare, and there would be no predicting when/how it would happen.

I would talk to your own mw, or any you are interviewing, about their protocols, experience, and training with different emergencies and then look at your own distance from the hospital. You may also want to find out about the local EMS in your area and response times to your home. I'd also look into the birth climate at the hospital you would go to... what kind of intervention rates do they have? Every parenting decision just seems to come down to a risk assessment for your family, combined with your own philosophical/faith-based outlooks.

[Earthy Mama]

I had a cord prolapse with my 2nd child. It is caused (usually) by PROM when the baby's head is not fully engaged in the pelvis. My membranes were artificially ruptured by the ob. The prolapse was not detected until I was pushing. The cord came out just before her head. The ob essentially "put her back" and held her head off of the cord until we were wheeled in to the OR.
In my case, the birth would have been safer had I been at home and NOT submitted to their interventions.

[babyjelly]

I want to point out hat the call-to-cut time is not always distance to hospital PLUS surg prep time...every mw I have ever spoken to will call the hospital as soon as she makes the call, and they will prep the OR while you are en route. Call to cut time will still be shorter if your closest hospital has round the clock staffing.
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[lunarlady]

Just to give you a time idea, in a true emergency my local hospital can do a c/s in about 10 min if there is IV access. It's not pretty, but it is fast. They have 24 hour OB and anesthesiology staffing, as well as several surgical suites and ER doc backup if they have 2 emergencies at once (unlikely in my small community). For my HB, I could go from calling 911 to c/s birth in about 30 min. I was comfortable with that window.