Questions for those who have BTDT.

[PosiesandPearls]

We are currently 12 weeks pregnant with our second. The birth of our daughter was a borderline traumatizing experience for me. So with much consideration and weighing of all of our options, we have decided to plan our first UC. We will continue with a "medwife" for our prenatal care, and for a back-up.

My mother had a my brother at home, unassisted, nearly 10 years ago. It ended in a transfer to the hospital after birth, so she can't quite give me the answers I'm looking for.

I'm not sure why, but one of my biggest concerns is tearing. I had an episiotomy with my first (after begging and pleading the OB not to cut me). I've convinced myself that because of this, I'll more than likely tear with this delivery. How do you judge if you need to go get stitches or not? Are there alternatives that can be done at home?

My other concern is that I am RH negative. With my first, I got the Rhogam shot a few hours after delivery. Should we just call after the baby is born? Or go into the hospital and explain the situation?

Thanks, ladies.

[Jaimee]

You mentioned that your mw is back up... how do you intend to have her as back up?  Does she know you plan to UC?  Has she agreed to be on call?  I'm sure other, more experienced UCers will have better answers for you, but if your mw is aware of your UC intentions, one option is asking her if she would come after the baby is born to do postpartum things like check you for tears, newborn exam (if you want), check the placenta, and a day later or so come back for another check up for your uterus and administer Rhogam.  One thing to consider, however, is that sometimes, if the mw was not there to see how the baby descended and came out she may not know where to look for hidden tears.  But, I know if it were me, I wouldn't want to go to the ER after the birth for these things.

[PosiesandPearls]

I use the term "medwife" because they work in an office, share the views as their OB doctors that they work with.. but carry the title of CNM. They don't do homebirths, and the two that I have met (there are 3 total, with two OBs above them) look down upon homebirths in general, let alone UCs. I don't plan on saying anything to any of them of our intentions. However, if something were to go wrong and we would need a hospital transfer, they are only a phone call away. That's my sense of back-up.

[Jaimee]

I see... so it's more of a don't call them/don't go in sort of situation.  I assume the midwives deliver at the hospital, not a free standing birth center?  Well, I think you've got a few options.  You could call them when you're in late labor just to alert them that you're in labor and then oops, have the baby at home, and go in afterward for all the postpartum stuff.  If you alert them, there wouldn't be a need to go to the ER, your midwife on call would be available to assist you, I assume.  You could even ask ahead of time what happens if you don't make to the hospital in time alert or no alert- find out that protocol- and decide if you'd like to do that.  And lastly, you can just decide not to receive any postpartum care unless you feel the need to get checked out later.  This is where my experience runs out as I had an "in between" UC where I had a midwife in my house, but not assisting in the birth.  She checked me and the baby afterward.  But, I do know that a lot of mamas just take it easy for a few weeks after the birth, not walking around a lot so that any tears just heal naturally.  As for Rhogam, you can purchase an Eldon Card for blood typing.  Get some blood from the cord or the placenta and type the baby's blood.  If it's positive then you'll need to make a decision about Rhogam with 72 hours, but I'm not sure where you could get it... if your midwives would still treat you if you hadn't come in after the birth or if you'd have to get it at the ER or some other clinic like Planned Parenthood?  If negative, no worries.

[PosiesandPearls]

Thanks so much! I wasn't aware that you could test the baby's blood at home. I'll be looking into that!

[dayiscoming2006]

I'd get 2 eldon cards to verify the result. They have a slight error rate. That's what I am doing anyway. You won't need any though unless you are Rh- of course and your baby's daddy is Rh+. 

I think I'll skip the Rhogam either way probably but haven't made a sure decision yet. I'm Rh-.

[PosiesandPearls]

I'm AB-. My husband is O+, daughter is A+. I think the chance of having a Rh- baby is somewhere in the 25% area..?

What's your reason for skipping the Rhogam, if you don't mind me asking? :)
 

Originally Posted by dayiscoming2006 

I'd get 2 eldon cards to verify the result. They have a slight error rate. That's what I am doing anyway. You won't need any though unless you are Rh- of course and your baby's daddy is Rh+. 

I think I'll skip the Rhogam either way probably but haven't made a sure decision yet. I'm Rh-.

[Oliver'sMom]

I'm also Rh- and dh is Rh+.  With my first homebirth, I was able to purchase the rhogam shot directly from my OB right after the birth (dh picked it up) and my mom, who is a family physician, gave me the shot.  It cost about $130 and they refused to let me use my insurance for it...probably for liability reasons.

With my second homebirth, I used a different midwife than with my first, and she had a stock pile of rhogam and was able to give me the shot herself.

[Peony]

I've skipped the Rhogam or taken it based on what my instinct tells me to do. I use the eldon cards to get the blood type of baby after birth. Last baby I felt during the pg I needed rhogam and made an arrangement with a UC friendly HB MW to get it from her. This time, I have no clear feelings either way but I can do the same arrangement again if I choose to. 

[dayiscoming2006]

Originally Posted by PosiesandPearls 

I'm AB-. My husband is O+, daughter is A+. I think the chance of having a Rh- baby is somewhere in the 25% area..?

What's your reason for skipping the Rhogam, if you don't mind me asking? :)
 

Done my research and I don't like the risks for myself. There could potentially be some disease or something passed through the blood product. That's always a risk because there's no perfect screening for it. 

I have 2 kids and never have had post-natal rhogam. The first is definitely Rh-, the second I am not sure about as I was in another country and they didn't tell me anything. Currently, I am not sensitized. I also believe in God's sovereignty in all things. I don't imagine women in Bible times getting their blood tested and then being injecting with blood products according to the result. In the end it's my decision to make. 

[Lizbiz]

I've had one homebirth and then one unassisted birth - I am RH negative and had a similar situation for back up, etc - as for the tearing - please keep in mind that if you think you've torn enough to warrant stitches, you do need to get stitched up (I'm fairly certain) within a few hours of the tear - if you wait a day - the swelling will prohibit stitches, and I have definitely heard of women who have regretted waiting and have had to have reconstructive surgery down there to get fixed up in the months afterward.  That does not sound like fun to me!  Some tears do indeed require medical care, and if you've had a past episiotomy, you'll want to be fully informed in case you do tear.  I do not say any of this to scare you, but truly, not all tears are of the "Hold your legs together for a week and it'll heal on its own" variety. 

We inspected me carefully down there after the birth to look for tears, and my husband was prepped on what to look for, as was I.  That may be something to prep for before your birth.

If you tear, I would call into your midwife and say, "Surprise!" and then get in and get stitched up, and then get the Rhogam at the same time if possible.  Just be very firm that you are fine, don't wish to be admitted to the hospital, and hold your ground about what you let them do to the baby too.  Maybe don't bring the baby, depending on how long this all takes?  

If you don't tear, then you have a bit more time - I believe the post-birth dose needs to be within 72 hours of the birth to be most effective.  I don't mean to start a religious debate at all, but I will offer that I also believe in God's sovereignty in all things - which is why He provides miracles of science like Rhogam (and yes, I'm aware there are risks with Rhogam - I've done my homework - but I've chosen to go with it).  I would do an Eldon card, but I would not fully trust its results.  In the end, we decided to get the Rhogam because we could not be certain that the Eldon card was 100% accurate, and we'd rather be safe than sorry. 

We went into the clinic 24 hours after the birth for Rhogam.  It was not a big deal - we just smiled, said as little as necessary, and went home.  

The infant and maternal mortality rates during Bible times must have been pretty high.  I'm pretty sure women back then would have been thrilled to have more options and the advances in healthcare that we have now.  A lot more of them (and their babies) would have lived.  We are truly blessed to live in these times, even if medically managed birth is nutty and scary in many ways, and something I've avoided.  But it's not because I'm not glad for medical technology.  I'm entirely blessed to have "back-up" at the hospital if I need it, rather than living in 100BC.  All that said, YES, in the end we each have to make our own decisions.  

[elevena true]

fortunately, i have not had to deal with tearing in any of my births.

however, if you were to tear and want to skip the ER or hospital all together for stitches, seaweed is a fantstic binder. your partner could read up now, and check for you after the birth, and you can even use the flat sushi nori sheets, moistened, to bind together your skin like a butterfly bandage. then you keep your legs together for the next couple of weeks, as much as possible. lo9ok it up, but it is a totally fantastic, natural option you could do for yourself at home. this would be my plan, in leiu of stitches, should it ever come up.

and mama, be prepared, yes, but visualize the elasticity of your vagina!! it will help you all through your pregnancy.... 

Edited by elevena true - 5/8/11 at 9:01pm

[dayiscoming2006]

Originally Posted by Lizbiz 

All that said, YES, in the end we each have to make our own decisions.  

Exactly.

[channelofpeace]

I had an unassisted birth with my last baby- entirely hands off, just me and my husband.  I was also sensitized to the little c antigen (likely during my dd's delivery).  There is no shot that can prevent little c sensitization- it is what it is.  But I often see in discussions of this nature that people forego Rhogam with the impression that they are less likely to be sensitized to anti-D in a UC.  And while that may be the case, I would hate for people to make that decision not knowing that yes, it is indeed possible to be sensitized during an ideal, hands-off UC.

Also, should a person be sensitized during a subsequent pregnancy, one of the treatments if the baby is being affected is doing in utero blood transfusions so the baby has adequate red blood cells since antibodies kill RBC.  It just seems like pertinent information since one of the objections against getting Rhogam is that it is a blood product.  Getting Rhogam now may very well keep a future baby from needing a blood transfusion. 

This is my third sensitized pregnancy (I am also sensitized to the kell antigen) and I wouldn't wish the stress of it on anyone.