Did anybody have to transfer to a hospital? Can you help a postpartum nurse out?

[MamatobabyA]

Hi mommas!  I'm excited to find and join this community and I was hoping you might be able to help me :)

I am a postpartum nurse and I'm very used to moms/babies who always have babies in the hospital and who want every intervention etc that we offer.  I think that's just fine for them.  I want their experience to be positive.

However, I have noticed a slow growing trend that we are admitting more and more new moms who intended to deliver at home or at our hospitals birthing center, but for whatever reason had to transfer and are now on my unit.  The problem is, I want these mom's to have a positive experience as well.  They are often very quiet and I'm just unsure how to care for them.  What can I do to make their experience better?

So, here's what I need :)  Do you all have any tips?  Anything that would have made your hospital experience better if it wasn't where you intended to deliver?

thanks!

[ocelotmom]

You totally rock for asking!!!!

I haven't had a homebirth transfer myself, but have had births under similar circumstances, so these are my thoughts:

Treat them as someone who has made a perfectly legitimate choices about labor and delivery. Reassure them that you respect them and want them to have the best stay possible under the circumstances.

 

Ask what they want/need, and maybe why they chose to deliver at home. People have different reasons for delivering at home - someone who has had previous bad hospital experiences is likely to have different needs than someone who chose homebirth because they had a previous precipitous delivery or for financial reasons.

Familiarize them with anything they may need to know about their postpartum stay (things like how to order meals, what they need to know about security measures, and things like that), as they're unlikely to have learned about that prenatally. If this has already been done, ask if there's anything they need to know - They may have been given the information under very stressful circumstances and not retained all of it.

Homebirthing parents are likely to be very dedicated to breastfeeding and attachment parenting, and be questioning of or against standard medical treatments (Vit. K, vaccinations, and so on). Support breastfeeding and rooming-in to the greatest extent possible. Minimize separation of mom and baby. Don't introduce artificial nipples without consent. Be extra careful about informing the parents about what is going on with the baby and getting consent before doing anything.

Advocate for quick treatment and releasing them as soon as is desired and medically advisable, especially if the mother is separated from the baby (ie. if there's been a postpartum transfer).

Be aware that they've paid (or are making payments on) several thousand dollars to the midwife (if it was a midwife-assisted birth), and that they're likely stressed about money, especially if finances or lack of adequate insurance coverage were part of the motivation to homebirth in the first place. Refer them to appropriate social services or charity programs if needed.

If you have time, encourage them to talk about how they're feeling about the transfer and whatever caused it. They probably had a lot emotionally invested in the birth, and may be grieving the loss of that experience. If the transfer was for something like maternal exhaustion or desiring pain medication, they may feel that they "failed". If it was for an emergency situation, they may feel traumatized. And if the mom or baby is not healthy, obviously they need emotional support for that.

Be aware that they may be afraid of CPS being contacted, especially if the birth was unassisted or they weren't using a legal homebirth midwife. If you can and it it seems relevant, reassure them in that regard. And, of course, don't get CPS involved unless there is actual cause for doing so. If a woman comes in with prenatal or L&D records from self-care or an illegal midwife that point to a specific problem, don't disregard them - take them seriously.

In summary - let them know you're on their side and want to be their advocate, and find out what they need as individuals :)

[gemasita]

Be extra careful about informing the parents about what is going on with the baby and getting consent before doing anything.

This is a big one, I think, because they may have chosen homebirth because they were afraid of interventions being pushed on them.  Most homebirth midwives are not going to just do something to them or the baby without consent so at home, they were probably able to relax about that.  So help them trust that that will not happen under your care either so they don't feel like they need to be on guard the whole time they are there.

[IdentityCrisisMama]

I agree largely with the PP.  

I would add that being respectful of the HB midwife and perhaps welcoming her into the fold would be really nice.  The only negative part of my transfer had to do with a bit of friction between my MW and the nurses and doctor on staff at the hospital.  It all got worked out but I wish my MW hadn't had to convince anyone that she was in her place to advocate for me.  

I also agree that it's nice of you to ask!!  

[Evergreen]

My homebirth transfer was a wonderful experience thanks to the nurses on duty. I live in a small town and personally knew almost all of them but I could tell they did go out of their way to treat me well. I hope they would do that for any mom and not just someone they knew.  Homebirth moms tend to be a bit 'crunchier' and might want things you wouldn't normally offer. Like, I was so happy when the nurses offered to bag my placenta. I wasn't going to ask because I didn't want to make any waves so their offering meant a lot. They also asked before they did anything to the baby and offered to bring all equipment to our room.

[emily11megan]

Be conscious of choices they make that may differ from other mothers.  Many HB mamas want to keep their babies naked, skin to skin.  They may not want a bath, and may have opted out of the erith. ointment at home, due to the knowledge that they are not carriers of STD.  I realize that most hospitals require this, but you could be sensitive and wait until after mother and baby have seen one another without goopy eyes.  They might be private women, who would like to be asked about people coming into the room, maybe you could put a sign on the door if she'd like privacy.  And most importantly, make sure she knows you aren't judging her for her choices, and you understand how disappointed she is about the transfer.  One big worry mamas have about transfer is the treatment and judgment they'll receive when they show up.  That alone will make a huge difference.  I am thrilled that nurses like you exist, THANK YOU!!!

[nilatti]

I just think you're awesome for asking! I, luckily, didn't have to transfer, but if I had, I would have loved to have a nurse who even bothered to think about this question.  :)

[Italiamom]

I would think that asking, instead of just doing, would be a big one.  For example, in labor, my midwife asked if she could check the baby's heartbeat, or asked if I would be willing to move into a new position.  And immediately postpartum, she asked if now would be an okay time to do the newborn exam, asked if now would be an okay time to check my vitals, and asked if we were wanting vitamin K, etc.

Even if something is normal procedure, ask the parents first.  And be flexible if they decline.  The vast majority of HBing mamas I know are SO much more informed.  If a mom declines something, it's most likely done not out of spite, but because the parents genuinely believe that it is best.

[Full Heart]

I have had 2 transfers and honestly there wasn't much I wanted out of the PP nurses.  Just leave me and my baby alone.  I certainly did not want to be asked why I was hbing.  And I def did not want to talk about the transfer with anyone outside my immediate circle of family and care providers.  Like most hb moms I declined most everything, PKU, Eye ointment, Vit K, Vax, and I do not and did not want to be questioned about those things (and I was).  Its not the time or the place to ask why (at a prenatal appt is one thing or at a peds appt after, not at the moment).  Just respect that I don't want them.    Don't be shocked when someone says they bfed for longer than 6 mos, 1 year, 2 years etc.  And don't be shocked if they are tandeming.   Women who transfer usually have no idea what to do in the hospital.  If there are rules, please let them know what those are.  Like if you require the room door to be closed or the baby taken with you when you use the restroom.  I would have liked to have known that BEFORE I got a knock on my bathroom door.

And yes, always ask for permission before you do anything.  Good advice if they are planning a hospital birth or come in from a hb.  This should be a rule.  Truthfully, just treat them normally.  We don't want to be "the hb mom"  or whatever.  We just want to be normal. 

[goinggreengirl]

My nurses during labor were great when we had to transfer due to exhaustion. The post partum nurses were okay as well. My DH was there since we don't have any other children he had to be caring for so he ran interference and always went with them when they took DS for exams. It would have been awesome if they'd offered to do the exams in the room. I'm sure I asked but they said the pedi had to see the baby in the nursery so not much they could have done. I agree that most mothers who planned on homebirthing probably would like as much time alone with their baby as possible. I had thought after DS was born that I would be snuggled with my baby in my own bed- instead I was in a strange room with an uncomfortable, tiny bed that I didn't feel comfortable sleeping in with my baby. 

[lunarlady]

I transferred for a retained placenta and PPH. Since I transferred after the birth, I was a patient but baby was not. I had to have somebody stay with baby and I at all times, since baby couldn't be a "visitor" by herself. While most of my stay was positive, the one thing I noticed was that baby was pretty much ignored. Since she wasn't a patient, the nurses pretty much ignored her. Nobody asked how she was doing, or if breast-feeding was going alright. Nobody wondered if she had dirty diapers, or of she was healthy or sick. My MW pretty much abandoned me to the hospital staff, which is another issue entirely, so the only one looking out for baby was family and myself. I didn't expect them to do vital checks or anything, but a friendly "how is baby today?" would have been nice. I was there three days. When the shift change happened, I think nobody told them baby wasn't a patient. Suddenly i had nurses offering me paci's and diapers, and a LC checking on how brestfeeding was going. The change was remarkable. Remember that caring for a newly postpartum mom also means helping her care for baby.

The other thing that i thought was funny, but was nice, was the way they asked me if i wanted medications. So they didn't just bring them. It was "the doctor has written you scripts for percocet, ibuprofen, a stool softener, and iron. Which would you like? Would you like them regularly, or should we wait for you to ask?". Maybe they do that for all moms, but I found it refreshing to be asked, not told. Doing things to me without my express consent is one of my fears related to being in the hospital.

[Vaske]

I wish I would have known more about what was available at the hospital and what wasn't, and at what point I would have been justified in making a fuss about certain things.  When I'm at home, I know exactly what I have, and where it is, and if necessary I can get up and get it myself.  I know everyone who is there, and I know when it is appropriate to give them a good chewing-out.  Transferring to the hospital was like taking an unplanned camping trip, right after giving birth, with a bunch of strangers.

[Engineering_Mama]

Originally Posted by ocelotmom 

You totally rock for asking!!!!

You've gotten some great advice already. I transferred to the hospital during the birth of my DD. My biggest issues postpartum were not being supported to breastfeed and that I desperately wanted to leave ASAP. I really, really appreciated the nurse who was sympathetic and just seemed to get that all I wanted was to go home. She told my DH what we needed to do/get to be released and then helped us get all of the paperwork done. So in general I'd say, be sympathetic and understanding. If you're not sure what they need or want ask them. If what they want isn't in your power explain to them what needs to happen or who they need to talk to to get what they need.

[MamatobabyA]

WOW!!!  Thanks everyone for the wonderful advice.  Really, the biggest thing is that most of my transfer mommies are just so quiet.  Goodness gracious it never occurred to me they might feel judged/scared!!  I will be sure to reassure them.  Mercy, I can't even imagine being afraid the NURSE might judge them.  How awful.  I really try to explain/offer things, not just "tell" them, but I will use extra care from now on. 

Thank you!

[First Time Mama]

 I have transferred from a planned home birth twice. The first time I felt judged for attempting a home birth ( and it ended in a c section and a huge sense of failure on my part) but that was more by the o.b and l and d nurse, not so much the postpartum nurses. This time was a much better experience ( I still got my vbac!). I guess the main thing I can think, is try to realize that they don't really want to be there. Even though I had a good birth experience at the hospital this time, I still wanted to be at home. I wanted to leave as soon as possible,  since I didn't really want to be there in the first place, and I wanted to get home to be in peace and quiet with my newborn. We  ended up staying two days and having a very frustrating postpartum stay, but this was because of conflicts with the pediatrician assigned to our son, we had several nurses that tried really hard to advocate for getting us out of there and I appreciated them. Thank you for asking this question!

[momtoS]

Okay I am pregnant and due in ten days with baby number three. I can't have my dream of a home birth this time. I am really really really really sad about it.

To help you I will tell you my experience with a hospital birth (with midwives/natural) and a homebirth.

Hospital birth.

Labour started 10:30am.

Went to hospital at 5:30pm, told nurses I was meeting midwives.

Nurses put me in a back room and ignored me.

Midwives arrived. I went to birthing room.

Nurses came in to put in IV. Tried and tried and tried. SEVEN times.

I was in the shower and went to the toilet. Someone came into the bathroom to take my blood.

I asked if she could wait until I was done on the toilet. Nope she was too busy.

I was making noise while in labour. Nurse told me to be quiet. I would have a sore throat if I made noise.

Birthed, stitched etc.

Nurse got wheelchair to bring me to a room, offered me a private, but didn't mention I would be charged for it.

Told me I had to call her within three hours to pee or she was going to put in catheter.

Rang her.

She came in and said " What do you want?"

Insisted on standing in the bathroom while I peed. I said no.

All night the nurses yelled and chatted down the hall to each other....no sleep for the patients.

Nurse came in and told me to roll over. Pulled down my pants. Checked me out. Left.

Breastfeeding nurse told me it was hard and I would just have to keep trying.

In the morning, I was offered to stay another night. I said no.

The only shower was down the hall. It was dirty and gross. No help.

I packed up and left. I had to walk to the elevator with baby and carseat....no offer to help or a wheelchair.

That's all I can think of off hand.

HOME BIRTH

Labour around midnight.

Called midwife.

In shower.

Very intense.

Midwives set up.

I made noise, screamed nothing was said.

I gave birth.

Nursed baby.

Got up...with help to go to the washroom.

Came back to a freshly made bed and baby.

Had a snack.

Midwives tidied up and left.

Snuggled with new baby.

So.....needless to say I have cried for two days straight thinking of my future hospital birth. It really sucks.

[Friday13th]

It's so refreshing that you're asking.  I really, really wanted to be left alone.  I got a lot of snarky comments and if you'd asked my I was having a HB I would have lost it.  I would make sure to ask before doing anything with the baby or mom and if they want early discharge to do your best to facilitate that.  I wanted nothing more than to go home ASAP, they started the process first thing in the morning and we didn't get out of there until 1pm.  It was awful and infuriating.

[jillybeans]

We transferred because my water broke at 35 weeks.  I was terrified.  I have very fast labors, so knew it wouldn't be long after we got there.  The nurse was amazing.  She didn't judge me at all, could see my fear, and reassured me it was going to be ok, that my baby coming out healthy was the most important thing.  She let me labor in any position I wanted, and when I told her it was my third and that there was no way the doctor was going to make it, that I was ready now, she didn't freak. She just very simply caught our daughter and layed her on my chest.  It was no big deal.  And when my dd started having breathing trouble about two hours later, she was very calm and informed me of what was going on.  She also helped me get released early to follow the ambulance to the big city hospital 2 hours away (I was driven by a relative) 

Overall she just did NOT judge me, was very friendly and supportive.  Even asked me some questions and acted interested, which helped crack my shell.

[MegBoz]

Lots of great advice! I had a planned hospital birth with my DS & really liked most of the nurses.

One much smaller thing though than what has already been said - I had NO IDEA there was a snack room I could just go to! Ha! I was stuck there for 48 hours PP and no one mentioned it until about 4 hours before I left! Wish I had known.

There was definitely not enough calories in the 3 meals a day I got, so I was hungry, but I felt bad asking nurses to bring me food & juice! I have a lot of respect for the profession of nursing & didn't want to treat them like waitresses. Wish I had known earlier that there was a whole room of snacks across the hall I could help myself too (although they were kind in bringing me things - they never made me feel I was inconviencing them by asking.)

Incidentally, even though in this PG I've had a small degree of 'shadow care' with the same hospital-CNMs who attended my DS birth and they're supportive of my HB plans & know my MW, I too would still worry about judgment from nurses as well as the OBs & some of the other CNMs if I transferred.

[goldenwillow]

Originally Posted by nilatti 

I just think you're awesome for asking! I, luckily, didn't have to transfer, but if I had, I would have loved to have a nurse who even bothered to think about this question.  :)

Agreed.  I am a tad more emotional about this today (well always) maybe just fired up a bit...  my good friend's cousin just experienced a transfer this past weekend and it was not a good one.

IF I were transferred (which I wasn't)...  I just wouldn't want a ton of people coming through the door, if at all.  Shift changes... get out of my face, I don't know you.  I am glad you are here to help... but please do not barge into my room.  Respect me and I will respect you. 

I think a transfer HB mama wants to feel empowered, as all women do.  Do not push any views, thoughts, attitudes on me... please just listen.  HB/BC mamas are not in the hospital because they want to be..  that said and I speak for myself, that they are not interested in hearing what MD's or RN's judgment on how or why a mama wanted to birth at home.  That is not the time for a lecture as a few of my friends have experienced. 

I believe that most all MD's and RN's embody the yearning to help their fellow woman/man, that is why they do what they do, right?  So...  choices on how "things are done" are different for everyone and that is not the time to "educate".  The most important things are the babe and mama.