Okay, so, I will ask my questions regarding each of the complications brought up. I would like to keep this thread as bias-free as possible- I really hope to get some answers and not speculation and commentary.
1. Cord prolapse. solution: EMS called, get on hands and knees with butt in the air, midwife or someone holds baby's head up manually to keep pressure off the cord, you ride in the ambulance that way and emergency section at the hospital.
1- How effective is it to get on hands and knees with the butt in the air? Does that actually help stop the cord from coming out?
2- How quickly does a transport to the hospital need to take place in order for a safe delivery?
3- What are the signs of cord prolapse? At what point should a good midwife start to think of transport?
2. Placental abruption. solution: emergency transport to hospital, emergency c-section.
1- What are the signs of a placental abruption?
2- When would a trained midwife know when to transport?
3- How quickly does a transport need to take place in order for a safe outcome? How quickly does it happen in a hospital?
3. Shoulder dystocia. solution: Gaskin maneuver, sometimes breaking baby's clavicle to get her/him out. This one is time-sensitive enough that it has to be handled at home, and midwives are trained to handle it.
1- When I read Ina May Gaskin's book, she made it seem like her method was effective the vast, vast majority of the time. Is this true?
2- How tragic are the effects?
3- How often does this occur and how is it handled in the hospital?
4. Head entrapment (breech). i have a friend whose baby died of this. It is much more common in mishandled breech births (where a careprovider manipulating, pulling on or sometimes even just touching the baby which causes the baby to unflex its head), so a planned breech HB will very very rarely result in this. For an unplanned breech the reaction will vary from MW to MW - ask ahead of time. If the MW is happy and comfortable delivering breeches she will most likely just get you into a good position with an open pelvis and NOT touch the baby until it is born. A less comfortable MW or a mama that wants it can call an ambulance before the baby is emerging (as soon as the breech is visible).
1- Do homebirth midwives deal well with head entrapment?
2- If a woman doesn't know her baby is breech and her midwife doesn't want to handle it, can she transport?
3- How often does head entrapment occur?
5. Uterine rupture. solution: emergency transport to hospital, emergency c-section and possible hysterectomy for mother.
1- Uterine rupture is more common in vbac's correct? How often does it happen in a woman with no previous cesarean?
2- What are the signs of uterine rupture?
3- At what point should a transport to the hospital take place?
4- How quickly does a transport need to take place for safe outcomes?
6. Baby not breathing after birth. (I have heard a story of this happening for no apparent reason and the baby died). My MW was fully trained in neonatal resus and had all the requisite equipment with her. My DD1 did need suction and oxygen to get going well and it was done very smoothly - baby was taken to window to observe skin tone in good light as they suctioned and gave some oxygen with mask, once she was beginning to stir she was put onto my chest to help her regulate her systems and i held the oxygen tube (with the mask off) under her face so it was blowing against her nose and mouth. Her apgars were 9, 7 and 10, i think the premature cutting of her cord was what caused the dip.
1- From what I understand, it is pretty common for midwives to be trained to resuscitate babies if they are not breathing, correct?
2- How often are midwives not able to help a baby to start breathing again? When is a transport to the hospital required?
3- I am assuming a quick transport would be needed. Is this something generally done at home before the transport?
4- What are the reasons for a baby not breathing? Can this be detected before hand?
7. Placenta accreta/increta/percreta. They would call EMS and transfer for PPH/non-delivered placenta and it would be dx and dealt with in the hospital.
1- I am not familiar with placenta accreta/increta/percreta. Could someone explain what this is and why it's so serious?
2- How urgent is it? When does this occur in the labor?
3- How quickly is a transport needed for a safe outcome?
4- What are the outcomes associated with this?
5- Are there any signs of this happening?
8. Postpartum hemorrhage. solutions: pitocin shot, shepherd's purse to manage at home; if bad enough, emergency transport to hospital and pitocin IV and possible blood transfusion.
1- How often does this happen? I feel like it happens pretty often.
2- Are homebirth midwives generally trained in handling this?
3- How quickly does a woman need to be transported to the hospital for a safe outcome?
4- Are there signs that a mother could possibly begin to hemorrhage?
Again- let's try to be as objective as possible so we can get some real answers and so women can objectively weigh the risks of homebirth against the risks of hospital birth.
I appreciate everyone's knowledge and help in navigating this!