Homebirth backup plan questions...

[APToddlerMama]

I'm toying with the idea of a homebirth, but I am wondering one thing... I had a preterm delivery last time around, and if I go into labor early this time, I definitely want to go to the hospital.  So what do you do then?  Go to the ER?  Do they "accept" you?  Are you supposed to bring records?  Which ones?  Do you preregister in case you might have to go so insurance picks it up or does that not matter?   TIA!

[Youngfrankenstein]

Are you going to do parallel care with an OB or CNM?  Is hb legal in your state?  Those things would affect the answer.  In Ohio, hb isn't legal buy our mw would be able to go into the hospital with us in case of transfer.  That was a must for us.  I did parallel care so if I'd gone into the hospital at any time, I would be treated as a regular patient.  That is the main reason I did parallel care.

[APToddlerMama]

Originally Posted by Youngfrankenstein 

Are you going to do parallel care with an OB or CNM?  Is hb legal in your state?  Those things would affect the answer.  In Ohio, hb isn't legal buy our mw would be able to go into the hospital with us in case of transfer.  That was a must for us.  I did parallel care so if I'd gone into the hospital at any time, I would be treated as a regular patient.  That is the main reason I did parallel care.

By parallel care do you mean doing to both an OB and a CNM?  I am *hoping* no.  HB is legal here, but I don't really wanted to be messed around with by an OB if I don't have to... 
 

[L&K'smommie]

In AK since HB is legal if for any reason I needed to deliver at the hospital whether for a preterm delivery or for a transfer my mw would go with me and I would be seen by whatever OB or CNM was on call at that time. I know my mw has one that she likes to transfer too but I only think that happens if it's before birth/labor of any kind. My mw would bring records and be able to relay any info needed to the on call doc.


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[APToddlerMama]

Originally Posted by L&K'smommie 

In AK since HB is legal if for any reason I needed to deliver at the hospital whether for a preterm delivery or for a transfer my mw would go with me and I would be seen by whatever OB or CNM was on call at that time. I know my mw has one that she likes to transfer too but I only think that happens if it's before birth/labor of any kind. My mw would bring records and be able to relay any info needed to the on call doc.


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Thank you!  So, do you notify the hospital before or preregister, or just show up in the ER? 

[kawa kamuri]

I see a group of CNMs who attend both hospital and home births. They work with OB who is their backup. I did pre-register at the hospital though I don't expect to end up there. I did forego a meet with the OB. That's how it goes in my situation anyway. Do you have a local AP (or something similar) group that you can ask? Local MWs? 

[cat13]

I was just talking to my mw about this same situation a couple of visits ago. I live in a REALLY small community with very few OBs, all of whom don't support hb (even though there's no law against it here). She told me that the few times she has had to transfer clients, that the staff didn't welcome her in the hospital (we only have 1 hospital to choose from). Because of this, I ended up also hiring a doula as well. My doula attends most of her births in this hospital, and has a good relationship with most of the OBs and nurses there, so DH and I won't be left to fend for ourselves if I have to transfer.

Also, in terms of having to pre-register, etc... I was told that if you come into the hospital in labor that they can't turn you away, regardless of where you have done your pre-natal care. And in my area, if you come to the hospital in labor, you just get the OB who is on-duty anyway, regardless of who your regular OB is.

In terms of insurance (I have an HMO), I was worried that maybe they wouldn't cover some of the hospital expenses if I didn't do my prenatal care with them. (I am doing all my mw and homebirth costs out of pocket).  I called the customer service number and found out that all costs are covered the same whether or not I planned to birth in the hospital or I just transferred at the last minute.

I guess that it just depends on where you life. Ask your mw what has happened in the past when her clients have transferred, which hospitals they have gone to, etc. And contact your insurance to see if it's all set.

Sorry for the long answer, but one more thing I wanted to point out. While trying to find all this information out, my DH brought up the fact that I shouldn't spend some much time & energy visualizing a transfer, but instead just spending my energy on visualizing a perfect home birth. But I know how my brain works... I can't "let go" of the "what-if-I-have-to-transfer" fears, unless I know that my back up plan is all set up. And now that I am confident in the back up plan, I really have let this fear go. Now... to work on the other fears!

Good luck with your planning!

[L&K'smommie]

Originally Posted by APToddlerMama 

Originally Posted by L&K'smommie

In AK since HB is legal if for any reason I needed to deliver at the hospital whether for a preterm delivery or for a transfer my mw would go with me and I would be seen by whatever OB or CNM was on call at that time. I know my mw has one that she likes to transfer too but I only think that happens if it's before birth/labor of any kind. My mw would bring records and be able to relay any info needed to the on call doc.


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Thank you! So, do you notify the hospital before or preregister, or just show up in the ER?

If I had needed it I would've just showed up at the ob ward...ours is set up so you can walk right onto it and not go to the ER as the ER doesn't deal with maternity/prenatal/birth.


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[mammamo]

I'm in Ohio, I used a DEM and if I would have had to go to the hossy I would've taken the Dr. on-call. My MW has a working relationship with the OB that called my negligent and irresponsible for wanting to homebirth, so I wouldn't have used him, nor would he have accepted me as a pt. (unless he was on-call, then I would've just had to bite the bullet, I guess) (I fired him in my first preg.) If it wasn't an emergent transfer I probably would've driven to a more urban hossy were they have more open mind. I didn't do shadow care, mostly because my PCP was very sympathetic and was willing to see me for sickness related stuff, and fill out any necessary birth paperwork. And my chiropractor was very willing to order things, and fill out paperwork as well.

[APToddlerMama]

Thank you everyone!  Now I guess I just have to decide what I am going to do.  We'll be moving in a month and so I will be changing providers regardless.  I am not sure a midwife is even going to be willing to see me anyhow because I have multiple "risk" factors but having the information either way will at least help me in my decision. 

[motherof4sons]

I am a homebirth midwife in NH and VT and can tell you that when this has happened, I meet my client at the hospital with her records and have already called the hospital to let them know what is going on, sometimes, I have already faxed records, but bring them for my own reference. We typically see the Dr. on call. Some hospitals are very kind and others are not. Regardless, I stay with my client until they are stable or they have a baby. I also continue my postpartum care as i would have when they go home. I think all midwives have their own way to address issues, and asking at the interview is important.

[Lynann]

I had a hospital transfer for my first birth. Our midwife came with us and brought the records. Because it was during labor she just called L&D before we left the house so they would be expecting us. We had to take the on-call OB/CNM but that would have been the case even if it had been a planned hospital birth. Our midwife also stayed with us for several hours, which really helped hold off some of the interventions.

I'd just ask what your CP would, or normally does, during a transfer so that you are prepared. We hadn't even considered it happening to us so it caught us off guard and we were so unprepared for being in a hospital for birth. At least this time I know what to expect IF it were ever to happen again (which I am confident it won't)

[labortrials]

I've maintained 'shadow care' for this very reason.  And I'm preregistered at the hosp.  Now I just hope & pray I don't go much later than 40w, cuz the OB will probably want to do stuff to me.

[kindchen]

This is exactly my problem with home birth. I have had two wonderful home births, but I'm still bothered by the back-up issue. I hear women on MDC talking about midwives who attend home births AND have hospital privileges, and I am jealous. I don't see that happening in my state any time soon.

My first was born at home a bit postdates. She was born on the last day I felt safe waiting, so I would have gone to the hospital the following day for an induction. I am SO thankful that I didn't need to do that, but it doesn't seem too unlikely that a future pregnancy would put me in the same situation.

I also had some minor health issues during pregnancy, and I couldn't find a doctor to see me, because of my planned home birth. One OB told me home birth horror stories when I was trying to get an appt. for an issue unrelated to my daughter's birth. My option for any medical care during pregnancy was the ER. I ended up just living with some very uncomfortable issues that could have been helped with medical care.

For my second pregnancy, I did shadow care. However, I still would have had an issue if my pregnancy had gone long again, because the OB would have wanted to induce during the window when I am comfortable with watchful waiting.

It really frustrates me that I can't take what I want from both professions!

To the OP: If you do want a home birth, you might want to contact midwives in your new community before you move. In some places, the home birth midwives are booked early. In your shoes, I would absolutely want shadow care, but I'm also thinking of having the next baby at the hospital, so I might not be your intended audience.

[Peony]

I've never registered at the hospital or done any sort of care with a provider that could attend a hospital birth. I've never felt the need to. If there is an issue during the pg that a HB MW can't deal with then I'll just transfer care at that point. If I end up transferring during birth or after then I will just get who is on-call. For me, I don't see the need in being an established patient with someone who more then likely won't be the on-call provider and I'll be dealing with someone anyway that I don't know for a problem that may or may not occur. 

[dogmom327]

HB is legal here so my understanding is that in the event of a transfer, we just show up at the hospital.  Depending on the urgency of the situation, the MW might call ahead and let them know we're coming (if it's a likely c-section and they need to prep). HB MW's can't practice in the hosptial but at most hospitals around here they're treated well and can act as a doula.

That being said, I've never pre-registered, had shadow care, etc.  I just didn't see the point.  If I transfer it's going to be an emergency and any hospital will have to take me.  The one thing I did do though was talk to DH and my MW about my wishes in the event of a transfer given that in an emergency I may not be able to be conscious for the birth, etc. (my preference for the type of incision, my preferences for having DH stay with the baby no matter what was going on with me, etc.).