Should I have a hospital transfer birth plan?

[Climbergirl]

I am planning a HBAC.

Basically, do I need to create a plan of what I want for a hospital birth in case of transfer or should I just make sure DH knows what I want? If so, what things would you include (because basically at that point, I would figure we are walking into a c-section).

Thoughts?

[turtlewomyn]

Are you using a midwife? I know several homebirth midwives that require a transfer plan of some sort (not just what you want while there, but how you get there, important phone numbers, etc.)

I am not that far along so I haven't thought about it too much, but yes, I would look at resources on planning a family centered cesarean as part of the plan.

[courtenay_e]

Having had a homebirth where I fired my midwife and transferred myself into the hospital for a difference of opinion in "care," and not having had a birth plan together for that situation (non-emergent transfer of care), I highly recommend having a birth plan ready.

That said, I also strongly recommend that you realize that it's quite rare that you'll fire your midwife and transfer yourself in a non-emergent situation. SOoooo, understand that when you are transporting, you are typically transporting for something more than you can get at home...that you will have to give up some of the "ideal" care that you were going to get at a homebirth.

So, I would suggest something along the lines of "I understand that we are coming to you for help, and I am willing to accept the help as it is necessary. I do ask that you understand that I am giving up my ideal birth by coming here, and that you do your best to help me attain as much of my birth plan as possible." And then that you keep things short and sweet, and in your own voice.

I would also have a bag packed (I didn't do that either, and had to use johnson's baby shampoo when I cleaned up...I had looong naturally curly hair, and the shampoo made it like hay, it was annoying!), "just in case" that you can forget about and unpack later, as well as the emergency transport plan which includes the route to the hospital, who you will call, and their number.

[cairomama]

A lot of hospital transfers are for pain relief or need for more monitoring, not necessarily a c-section. Having a transfer plan and a bag packed is not going to make you more or less likely to transfer. It will make your transfer better. Even though most moms relax better at home there are some women who can't relax at home and have the baby shortly after going to the hospital.

A homebirth transfer plan should include how you are going to get to the hospital, which hospital you are going to go to and what your midwife will do. Will she come with you and act as a doula or will you go by yourself?

[rainbowmoon]

why in the world would you feel like you are walking into a c/s by transferring? there are a million things that could warrant a transfer and NOT end up in surgery. I would definitely make a transfer plan. I did not when I planned my UBAC and thankfully my birth went exceptionally well when I transferred during transition but I wished I had! I went in barefoot with just a robe and then was helicoptered to another city. Wished i had brought my cell phone and socks at the very least!

[Climbergirl]

Originally Posted by rainbowmoon

why in the world would you feel like you are walking into a c/s by transferring? there are a million things that could warrant a transfer and NOT end up in surgery. I would definitely make a transfer plan.

I don't know. I guess because my last birth was so very traumatic and I don't trust doctors anymore. And, that I would get whoever is on-call and that people may or may not be VBAC friendly. And, I guess after my last birth, I kinda need to assume a c-section so that if I do get a hospital VBAC, mentally, that would just be better.

Our midwife will come with us. She is legal in our state which is why we went with a CNM.

Does anyone have an example of a transfer birth plan?

[sattygirl99]

I did not... Since we were only intending to transfer in cases of fetal or maternal distress, which would mean surgery (transfering for pain was not an option for me), I chose not to.

It's a personal choice... For me, by having a plan made it far too much of a reality that transfer was possible... And I kept the mentality that I would have the birth I wanted, the way I wanted. And I did...

[rainbowmoon]

it's definitely not all or nothing if you transfer. especially if you are far along in labor. there may not even be time for surgery. I didn't transfer for pain relief and neither of my two complications required a surgical birth (though I did have a d&c due to a placenta accreta post birth I still got my natural VBAC) everyone on call in both hospitals were extremely respectful so I guess I got lucky.

I think it's crazy not to make a "just in case" plan at the very least. (and I speak from experience of not doing so!) if you are worried about meeting an on call doc you could always find an OB you like and trust you could hire as a back up. (They do exist I promise!)

[CookAMH]

I absolutely would, whether it's an HBAC, birth center birth (non vbac) or homebirth (non vbac). Have your bases covered for what ifs so that should it happen, your wishes have been expressed.

Don't assume it's a c/s though, have a birth plan for continued labor, and wishes in the event of a rcs. If I went in for a rcs, there are particular things I would request for how surgery and post-surgery would go.

[Aliy]

I know my midwife requires a plan written up. I would just in case

[Aliy]

oh and if your thinking it's going to be for a c section ( there are other reasons) you will still want them to know what you want for after birth and all that sorts of stuff

[misskira]

I was planning a birth center birth that didn't work out. We ended up at the hospital. What we focused on most was what we wanted to happen after the baby was born. Ground rules were dh goes with ds everywhere and skin to skin with him asap, they don't weigh/measure baby until i'm back from the surgery and after we've initiated breast feeding, and no bath at all (we do it at home). Our hospital doesn't have a nursery and does everything in room so it went well. Oh, we were also clear about no hep b vax and no circ. And that we would be cloth diapering. And no bottle or pacifier.

We did include details of the birth, such as preference for intermittent monitoring unless needed, our goal of avoiding an epidural and our request to be included in decision making. I figured that if we were at the hospital than it was for a reason, so we didn't focus much on the labor piece.

[chellebee]

I absolutely would, under any birthing situation...just because birth is birth, and sometimes things happen. I would say this to a mom who has had 4 successful vaginal homebirths and I would say this to a person having an HBAC.

Things I find important in transfer plans is emphasizing a desire consent to all procedures for mom and baby, and ESPECIALLY newborn care decisions. Something like whether or not you want your baby to receive hep B is unlikely to change because of a birth situation.

If you write it up, it's done. You tuck it away, assign someone to be responsible for staff reading it if a transfer happens and forget about it unless it becomes an issue.

[MsBlack]

I agree--transferring care will NOT necessarily mean another csec. Heck, I accompanied transfer for epidural for a VBA3C (THREE!), and she got her vbac! That is because a) she and baby were ok and b) she knew to repeat these words as often as necessary: "as long as me and my baby are fine, I do not consent to surgery" (and it was necessary to say it multiple times during the 6hrs we were there before birth).

Choose carefully from among your hospital options, and think carefully about what will and will not be ok with you in terms of care, in advance.

As a hb and UC mom, I always had a back up plan. I've heard some moms tell me that is 'negative thinking' but I say, that's hogwash. I had 5 happy hbs including 3 successful UCs--and w/last baby, transfer that ultimately led to csec (my choice, and needed). Having a back up plan helped me stay MORE positive and relaxed, not less so.

Here is the link to my essay on 'alternative birth plan' from my website. It doesn't go into details of possible plans--but is meant as food for thought for families considering what plan to make (all hb fams, not just HBAC). Maybe you will find it helpful as you consider your alternative, 'just in case' plan:

http://womynwisespeaks.wordpress.com...e-birth-plans/

[shenanegans]

climbergirl- I had the exact same perspective when I was planning for my hbac. I assumed that if I was transferring to the hospital it meant a c-section. I had discussed all of my ideas with my midwife and we were totally on the same page so I assumed I didn't need to write a birth plan, but she encouraged me to do one anyway, not for the homebirth part but just something simple in case of transfer. I used an online template and that worked fine. On the other hand, I didn't pack a hospital bag. I just didn't want to open that door! haha. the HBAC was perfect so I never needed it anyway.

[Kimrose]

Okay - I am NOT adding negative/"this might happen" vibes- but did want to add from experience as to why it might matter... My first birth was natural labor to pushing when they realized my DS was breech/emergency c-section I did have a "c-section section" in my birth plan...but did not even (want to) THINK of an emergency/unconscious section That said - my DH did KNOW and remember the "if anything ever happened - STAY WITH THE BABY!" part...and did first/mostly then came back to check on me. That said - an "emergency" was scary for him too - and he was worried about both of us...and may not have remembered "details" as much since like everyone - you don't want to "focus" on worst case scenario and we didn't. The things that happened that I wished didn't (aside from the whole "missed breech"/no one knowing how to deliver vaginal breech, etc. , was my DS receiving a bath, not being given right to DH to hold/keep with us, etc. So the ONLY time he was "away" from us was when he was the newest...once I woke up and "met him" he never left my sight. I STILL hate that there are moments when he was THAT new and little that his parents weren't there - that we don't "really" know exactly what was done...it hurts my heart - and though I couldn't change anything else - if we had discussed that in more detail - he would have had it in his head and known it would upset me. You never want to think you might not "be able" to even state your wishes - but I think it's only smart to consider it, communicate it, write it down - and then FORGET IT and hope it's never needed. I'm 22+ weeks along now - shooting for a VBAC w/a T incision and anterior placenta - ugh - but that's exactly what I'll be doing. Plan for everything/just to have it done - then let it go completely and hope it's NEVER needed!!!!!
Wishing you a PERFECT birth!! ♥

[mizznicole]

I absolutely would have a plan.

I transferred from a birth center and had a c-sec. Because of no written plan, they did things to baby that I didn't want - scrubbing down, eye goup, possibly hep B (all AGAINST MY SIGNED REFUSAL). You can't rely on an exhausted hubby to direct the nurses. For his sake, have something down on paper!

Luckily we were at a 100% pro-breastfeeding hospital with no nursery, so we were covered there.

[_ktg_]

I think you should have a plan for transfer which outlines your goals for birth to communicate that to the team.

Personally - planning and writing down my wishes for all possible outcomes (transfer, c/section, or death) would help my advocates to ensure everyone is on the same page when exhaustion is kicking in, emotions are running high, and in various directions and clear communication is not always the clearest.

Take time, write down your wishes for every scenario and then tuck them away or give them to your doula to hang onto sort of like a "don't break glass unless emergency" situation.

[_ktg_]

Originally Posted by MsBlack

Here is the link to my essay on 'alternative birth plan' from my website. It doesn't go into details of possible plans--but is meant as food for thought for families considering what plan to make (all hb fams, not just HBAC). Maybe you will find it helpful as you consider your alternative, 'just in case' plan:

http://womynwisespeaks.wordpress.com...e-birth-plans/

OT - but MsBlack this is a wonderful essay!

[MsBlack]

Thanks, ktg--nice to know my work is appreciated