Choosing a hospital for emergency back-up

[HeatherB]

In my last two homebirths, there was only one hospital nearby, so it was clear where we'd go if we had an emergency. Now, there's one that's probably slightly closer and one that's a bit further away, in addition to the first.

I'm thinking I should call and ask some questions to get an idea for which hospital is best in case of the unexpected, but I'm having trouble thinking of what those should be... Anyone have a list?

One thing I KNOW I should ask is if they have doctors 24/7 that can do an emergency c/s if necessary. But that's all I can think of.

[lunarlady]

Visiting hours were important for me, and you might want to ask about rooms. Some places have you in different rooms for L&D and recovery, some you stay in the same room the whole time. Natural childbirth % can give you some idea of the level of support you will get as a HB transfer. You might ask about pain management options, and how quickly they can do c/s in a true emergency. The hospital I transferred to could do one in 10 minutes if they have IV access.

[cagirlintexas]

From what my mom says who was an ER nurse its not about having a doctor on staff that does c-sections but having a anesthesiologist on staff 24 hours. I guess not all hospitals do. Let me know what you figure out. It would be good to know.

[Comtessa]

We also had two hospitals nearby and we decided that we would transfer to the closer one in a "true" emergency and to the farther (preferred) one in a non-emergency. We did end up as a non-emergency transfer at my preferred hospital, and I am glad we made those plans so carefully.

Here's what I recommend when choosing a transfer hospital:
- go for a tour of the L&D floor. I highly recommend doing this, even if you think you won't end up there, because if you do end up there, it will be less scary if you've already "got the lay of the land," so to speak. This made a very big difference for me and made me feel like I was still "in control" during my transfer. A call won't tell you what you need to know; I really recommend getting in there and checking it out.
- ask a lot of questions about natural childbirth and c-section rates. As a PP suggested, how they answer these will give you a clue as to how you might be likely to be treated as a HB transfer.
- Ask how they handle birth plans. (If they say, "what's a birth plan?" run screaming in the opposite direction!) What is the process for ensuring that your birth plan is followed? (Ours was, even though we were a transfer.)
- Ask if they have any midwives who work there. Feel out the nurse giving the tour about how s/he feels about the midwives, if there are any. This will give you a bit of a clue as to how much respect your MW will get if she comes to the hospital with you. (My MW wasn't allowed into my room when we got there!!! I had to fight to get her in there at all.) Ask about doulas, too, since your MW will probably have to serve "officially" as a doula in case of transfer.
- At your tour, see if they will give you pre-registration materials. Often they'll have a folder that describes their various policies, and you can decide which hospital's policies you'd rather live with. Having pre-registration materials filled out and signed, along with a birth plan (signed by your backup doc, if you have one) will help speed up the transfer process significantly. Put them in an envelope in your transfer bag, along with your driver's license. Getting them ahead of time also gives you a chance to read them carefully and CROSS STUFF OUT on the consent form if you do not wish to give blanket consent. I think I added a handwritten line that said something like, "I withdraw consent for any medical procedure unless hospital staff receives explicit verbal consent from me or DH at the time of the procedure."
- IMPORTANT: ask lots of questions about newborn-baby policies. Sometimes hospitals say all the things they think women want to hear about labor and birth, but they don't talk much about the way they handle newborns. What is their standard of care? Are they designated as a "baby-friendly" hospital? Do they have a policy that the newborn "must" go to the nursery for any reason? I had to be very explicit in my birth plan that the baby was NOT to go to the nursery EVER, and I still had to chase her bassinet down the hall once when they took her WITHOUT ASKING ME in the middle of the night.
- You'll want to ask a lot of questions about this sort of thing to find out what they do at each of your possible hospitals. Also, ask about things like: will you honor a request for delayed cord clamping? What is your process for refusing Vit K/eye goop/vaccinations/etc.? (And, will you call CPS on me if I don't give my child eye goop within 20 minutes of its birth?) If I need a C-section can my partner/MW/mom/whoever be in the room with me? I want to watch the baby be born; will you lower the curtain during the surgery so I can see the birth? Etc. All the sorts of questions you'd ask if you were considering birthing there on purpose, you should also ask if you're considering it as a transfer hospital.

Good luck! HTH!

[ShwarmaQueen]

When I transferred for retained placenta and PPH, there was ONE, only ONE, OBGYN in the whole hospital and it took over half an hour for her to get to me because when I arrived she was at a delivery. If I needed a true emergency c-section, I don't know what would have happened. Next time I will ask how many doctors a hospital has on call who can perform a c-section, because obviously, this was unacceptable in terms of medical 'care'.

[AnneCordelia]

I would want to know only emergent info: is there an anesthesiologist on staff 24/7? Is there a neonatologist and OB/GYN on staff? What level is the NICU?

[gemasita]

We also have a nearby (non-preferred) hospital and a further one (preferred). The one that is further away is the one that typically accepts homebirth and birth center transfers with no questions asked. The closer one - we aren't sure what they will think.

I'm a doula and I think if you asked your midwife and/or local doulas, you will easily find out which hospitals are the best for homebirth transports. For example, our preferred hospital is the only one where you would really have a chance of skin-to-skin in the OR after a c-section and have the baby in the recovery room with you. That hospital is very natural-childbirth-friendly but also the best for an emergency transport that might end in surgery. For me, personally, that's my criteria for a "good" hospital to transport to.

[HeatherB]

Thanks for the input. Anesthesia is definitely an important question, too.

The somewhat closer hospital (and we're talking 10-12 minutes versus 5-7, really) is also very new, so I'm not expecting my MW has ever had to transfer there. I've taken my DS there when he had appendicitis and was quite happy with the pediatric staff, but I have no clue about their OB department at all.

The other hospital (10-12 minutes, well-established) is a busy birthing center that just expanded. It's "the" place that most women go to around here, but is busy enough that they *highly* encourage scheduling your birth so you can be assured a room. Being that they used to be the closest ER, we've been there a few times, too, but that obviously doesn't mean much.

The other newer hospital is probably 15-18 minutes away. I haven't heard anything about their maternity care at all.

I know if there was something non-emergent we'd probably transfer to a very so-so hospital that has a doc who has worked with all the midwives, and a couple of nurses who ARE midwives. I've met that doc but not done more because we'd only go in case of something non-emergent. If there was a true problem and we needed care NOW, it's much too far away (about 30-35 minutes).

I've never really worried about details on the emergency transfer plan in the past because there was one obvious choice. But having heard stories of HB transfers gone awry because no one knew anything about the hospital they chose has given me pause, especially because we DO have options now.

[lunarlady]

For my recent transfer, I went to the closer, older, and smaller hospital. I'm glad I did because I had 5 nurses and a OB waiting for me when I arrived with retained placenta and PPH. Because they are not "the place to birth" they were much less busy, and I think this contributed to the excellent level of care I received. Note that I was transferring for me, not baby. If we were transferring for baby, we would have gone to a hospital that is much further away (20 min., at least) but that has a NICU. The other area hospitals transfer very sick babies there, or airlift them to the children's hospital that is an hour by car.

[proudmomof4]

I agree with Comtessa's post.

I never had transfer to a hospital (4 homebirths) but I always had a back-up plan.

Going to a hospital for a tour will tell you much more about the atmosphere there than simply calling. I even "stopped by" unannounced because I wanted to get a picture for myself (not just a slide-show). Also, as mentioned by Comtessa, in case you really end up in a hospital it's a little less scary if you've been there before.

It might help you to have a catalogue of questions (rate of C-sections, policies about rooming-in, NICU, persons allowed with you, support staff for BF, ...).
Be sure to do a reality check: if the nurse is telling you how they are supportive of rooming in but the nursery is full of babies - it should make you think. If the nurse gets all excited about BF but the first thing on the ward that caught your eye was a poster with a formula brand name or even samples - again, this might put her words into perspective...

Finally: be prepared, just in case. Comtessa mentioned the paperwork, I'd also like to suggest a travel bag or small suitcase ready to grab with essentials for you and baby. In other words: pretend you were planning to go to the hospital. Pack some toiletries and a change of clothes for yourself and baby. Have baby's car seat ready. (The last thing you need during a transfer is having to hunt for your favorite nightgown, your toiletrybag, or whatever.)

[MsBlack]

Originally Posted by gemasita

We also have a nearby (non-preferred) hospital and a further one (preferred). The one that is further away is the one that typically accepts homebirth and birth center transfers with no questions asked. The closer one - we aren't sure what they will think.

I'm a doula and I think if you asked your midwife and/or local doulas, you will easily find out which hospitals are the best for homebirth transports. For example, our preferred hospital is the only one where you would really have a chance of skin-to-skin in the OR after a c-section and have the baby in the recovery room with you. That hospital is very natural-childbirth-friendly but also the best for an emergency transport that might end in surgery. For me, personally, that's my criteria for a "good" hospital to transport to.

ITA. I said more about this issue in this thread, post #10:

http://www.mothering.com/discussions....php?t=1258336

[MegBoz]

Originally Posted by Comtessa

- IMPORTANT: ask lots of questions about newborn-baby policies.

Great post & I totally agree.

It's obviously upsetting enough to have to transfer, but then to have to fight to not have your baby taken from you, given formula, etc. is something better avoided if you can avoid it!

I just wanted to add - ask if they can do all standard newborn procedures, including a bath (if you want one) right in your room. They may want to weigh the baby every few hours (I think it was 4 at my hospital) & check other vitals. Can they always do all that in your room? (and even if they can, WILL they without a fight?!)

Originally Posted by HeatherB

Being that they used to be the closest ER, we've been there a few times, too, but that obviously doesn't mean much.

Yeah, I kinda have the impression that other facilities in a hospital are totally unrelated to maternity care. For example, as a healthy woman I would NEVER birth at Johns Hopkins (was going there initially, but thankfully got educated & switched out - so I'm familiar with their policies.) But it's one of the best hospitals in the nation according to US News & World report.

Likewise, I'd UC before setting foot in GBMC. It has the highest CS rate in the state at 44% & the OBs there 'red-lined' half my friends birth plan (she also switched out!) But their ear, nose & throat practice is supposed to be great. I had my tonsils out there years ago & was happy with that.

[ARG2003]

We have two hospitals nearby. Our midwives transfer to one specifically because that is the hospital that has a NICU and they have a working relationship with the staff there. The other hospital has all the right stuff for people who plan a hospital birth (it's where we had our son). But we only plan to transfer if there is an emergency, so it is more important to have helpful staff who know our MWs and can care for baby than anything else.