Tell me about transferring to the hospital

[milomama]

I'm pregnant with my second.  After DS was born in 2009, I had a postpartum hemorrhage.  I really want a HB this time, and am reading all I can on preventing PPH.  My midwives are telling me "we recommend a hospital birth, but it is your choice."  My one MW keeps telling me it would be awful to have this great birth at home, hemorrhage, and the end up at the hospital.  But I'm not sure that's a great reason for me...I mean what if I don't end up needing a transfer?  If I go to the hospital, I will for sure be at the hospital, at higher risk of all kinds of interventions and such, and feeling the stress of a hospital.  At a HB, I may need a transfer, but what if I don't?  Additionally, with my PPH, I didn't feel like everything happened "so fast".  I'm 10 minutes from the hospital, and I feel like we could have transferred "in time." I also didn't transfer to the doctor until about 1 hour after birth.

So...to stop rambling and ask my question...how valid is the idea that "you don't want to have to transfer"?  Can those of you who have had a transfer during/after a HB tell me how it affected you?  Were you still happy to have been at home for the portion you were?  If after the birth, does baby come with you to the hospital?  What reasons besides hemorrhage are valid for transfer?  Anything you can tell me about how it is emotionally to deal with a transfer would help me process everything!  It's feeling like this huge decision, though my gut has strongly said HB since I found out I was pregnant!

[gitanamama]

I had a home birth and also experienced PPH. However, my midwife was able to treat me at home (by giving me injections of oxytocin) and I didn't end up needing to be transferred to the hospital. It was a little bit scary but I had total faith in my midwife and she did an awesome job of controlling the situation and making sure I was safe. 

I think it's important to take into consideration the recommendations of your midwives, but in the end, the decision is yours. If your gut says HB, I would go with it. A PPH doesn't automatically mean hospital transfer and it's possible that you won't even suffer from another PPH (right?) Also, I believe that your mental/psychological state has a lot to do with your body and how you birth. If you go into this birth expecting PPH and expecting a hospital transfer, I feel like it's more likely that both of those will happen. Maybe you could focus on visualizing a healthy home birth (and post birth) instead.

One final idea--I took my placenta a little while after birth and almost immediately after, I stopped hemorrhaging. I had also been given two injections of oxytocin by then, which probably had a lot to do with stopping the bleeding, but my midwife said that she's often seen women stop bleeding after taking their placenta. The idea of it really grossed me out at first (I'm a vegetarian!) but in the moment, I was fine with it and was glad my midwife suggested it. 

~Blessings on your pregnancy--I'm sure you'll have a wonderful, healthy home birth! ~

[abc123xyz]

I have had two births and had PPH with both. My first was 44 hours long and second 10 hours so the length of my labors really play no factor. We transferred during labor with my first due to "positioning problems" but looking back, would have rather stayed home. They gave my cytotec to stop the PPH and knowing what I know now about that, I would have refused!!! My second was a homebirth and if I didn't have a skilled MW, may not have made it to the hospital. I'm not sure how bad it truly was but enough to warrant action. I passed fist sized clots for about 20 minutes after placenta delivery and she decided to lay me with baby nursing in bed, gave me liquid iron I had in my fridge and methergine. (sp?) They have it in injection form or pill form. I took the pill form and it did slow the bleeding some but I still passed big clots of blood for a couple hours and was pretty weak and low energy for some time even though I was on a birth high! I feel like it depends on the management of the situation. If your MW's are not giving you comfort in their technique, are there other MW's you can talk to in your area? I know what I go through post birth so I want the medications available if I need them! It would be silly to not have them and risk your life! I don't think it's unreasonable to say you DO NOT want to transfer. Barring death, we refuse to transfer based on our transfer experience with our first. It was mishandled and mismanaged so horribly in the hospital and I can't imagine being there for any reason other than death. Sometimes PPH can be that reason if it's severe enough but typically in a homebirth, it's much easier to manage and the warning signs of danger are present early enough on to get you to the right place! Hope you can find some comfort? Good luck with your decision. Know that whatever you decide is what's best for you and your baby no matter what and sometimes we have to surrender our personal convictions in order to be wise! I am finally just discovering this myself!

[Comtessa]

We transferred with our first and decided on a hospital birth for our second as a result.  I thought for sure I was going to hate the whole hospital experience the second time around, but to tell you the truth, it was a really positive experience for all of us.  But that's just me, and it has more to do with having VERY good options for a good hospital and excellent MW this time around.  If I hadn't had those options available (I didn't with my first), I would have planned another HB for sure.  If I had to birth at the same hospital we went to with my first -- I would totally accept the risk of another transfer over the risk of being in labor in that hospital setting. 

Our transfer was non-emergent, for exhaustion, and the whole transfer experience was pretty depressing.  It could definitely have been worse!  But I will say this: if I had started at the hospital with my first, I would almost definitely have ended up with a cascade of interventions and a C-section.  My labor was nearly 52 hours, and I pushed for 4 hours.   It was hard, but I wouldn't have traded a minute of my labor at home for anything.  It was such a positive experience, my MW was great, and I was so happy to be there.  The transfer sucked, but it was OK because I felt like I'd done everything I could to stay at home.  If I'd birthed at home, then transferred for PPH, I think I would have felt the same way -- like, "I did this at home, and I'm happy with that, and now we're here 'cause we need help."  Right? 

In terms of being prepared for a PPH at home... there are a few things you can do.  My MW had me get a bottle of liquid chlorophyll to have at home -- I think it's supposed to help in the case of blood loss.  You could look into that.  I loved the stuff; put it in green smoothies for months.  Also, check to be sure your MW's carry pitocin or some other drugs that they can use in the case of PPH.  And have a transfer backup plan: pack a bag, have a birth plan, etc.  That way if you have to transfer, you'll feel prepared and empowered to handle it.  I was really grateful that I was well-prepared for transfer, because it went very smoothly when we got there. 

You might want to call the L&D at the hospital where you'd go, and ask, "in this situation, what would be the normal protocol?"  Questions like, what happens with the baby if you're admitted and s/he is not?  Etc.  There's one OB in our area who will call CPS on any mom who comes into her hospital with a HB transfer.  !!!  Might be good to ensure that you don't have any whackjobs like that working at your chosen hospital, too. 

[lunarlady]

I had a home birth and transfered to the hospital after due to a retained placenta and severe PPH. Yes, it sucked. More than just the actual act of transferring, I think the worst part was the fear my DH experienced. I was bleeding heavily, and we called 911 and I was transferred via ambulance. It was a true emergancy, and the urgency and concern displayed by the medical professionals frightened my DH quite badly. I ended up needing quite a lot of fluids and a two blood transfusions. Overall, it was not a good birth experience, and I never, ever want to do it again.

That said, I do not feel PPH in and of itself is reason not to home birth. My first home birth went fine, and was actually a magnificent experience. A wonderful birth is worth trying for. However, I would only HB again if I had a MW who I had 100% faith and trust in her ability to save both my life and baby's life if things went very wrong during the birth. A huge part of my trauma from my birth and transfer was the fear and inept handling of the situation displayed by my MW. So if I were you, I would find someone who would a) be prepared to handle a PPH b) Has handled PPH before and c) is totally willing to hold your hand and to transfer with you to the hospital if necessary. Severe blood loss is not to be trifled with.

Also, you should discuss with your MW about the management of your final stage of labor so that measures can be taken to minimize your chances of PPH.

Finally, please know that the actual transfer part of my labor was not terrible. The paramedics were kind and prompt, the firemen were careful of my modesty and dignity as they carried me out of the house, the nurses and doctors were kind and compassionate in their care, and my hospital stay was actually far more restful and healing than I ever thought it could be. In fact, I actually found the hospital nice enough that if I can ever convince DH to do this again, I may be having my last baby there. It would set my family's mind at ease to have me at the hospital for the delivery, and having done this a few times, I know I could walk in just before pushing and not open the door to too many unwanted interventions.

The two things that make me so happy I had a HB, even a traumatic one is that my DD1 got to see her baby sister born, and my DD2 spent the first 20 minutes on the outside snuggled to my chest still on the cord. Although I was a patient at the hospital, DD2 never was, so I never had to argue with anyone about eye goop, shots, or newborn bloodwork. It's these things that made me choose HB in the first place, and that I would need to sort out in advance if I were ever to birth in a hospital.

Good luck with your decision. Sorry if this is rambling, but I am trying to answer your question without scaring you unnecessarily. Feel free to ask if you want more info on the nitty gritty details of transferring with a PPH.

[Lula's Mom]

I had PPH with my first, a homebirth with CNMs.  They gave me pitocin twice, IV fluids (I already had a line in for the gbs antibiotics) and did that horribly unpleasant "uterine masage".  IMO it was caused by mismanagement of the 3rd stage. They cut the cord a minute after the baby was out, though I had requested to wait much longer.  She said she cut it because she wanted me out of the birth pool so she could really see how much blood there was. That I can understand, but I could have gotten out with the cord still attached.  I think that cutting it right away left too much blood in the placenta, and my uterus couldn't clamp down well on it like it should have.  This is the theory that she and I discussed later.  There was time to go to the hospital if we had needed to.

For my second birth, I was a little worried about PPH, but I wanted a UC, not a hospital birth!  So right after ds was born, I had a dime-sized piece of the placenta.  I also had herb tinctures on hand, but I didn't bleed abnormally and didn't take them.

For my third birth, we had another UC.  This time a piece of the placenta broke off and came out before the rest did.  So there were a few big clots right away and my husband was worried.  But the baby nursed right away, the rest of the placenta came out, and I did not have PPH.  I would have eaten the placenta again if there had been heavy bleeding.

So yeah, having been in this situation, I would (and did) definitely homebirth.  There's a good chance you won't have PPH. If you do, there are things that can be done at home to treat you. And if that fails, then I'd go to the hospital.

[milomama]

Thanks a lot for the insight.  I am planning a HB until I am convinced otherwise by the MWs.  I am telling myself that I won't hemorrhage again, since chances are that's true, right?  

A couple replies mentioned the management of the third stage.  Last time I had a managed third stage: cord traction, pitocin shot right after baby was out, early cord clamping.  My MWs this time think we should still do this.  My research thus far has convinced me to request the opposite this time...basically leave me and baby alone to get to know each other and nurse and the placenta sort itself out.  For those who mentioned the third stage, what have you decided is best for preventing hemorrhage?

Also...the eating the placenta is something I've come across a bit, but I am unclear on.  How much?  How do you get it down?  Do you just get someone to go to the kitchen and lop off a bit with a knife to eat?  I must admit it's a bit to get my head around that one, but when faced with a emergency hospital trip I think I'd take placenta.  

I really do appreciate the thoughtful replies.  It helps a lot in making the decision to hear from those who have been there, in a non-judgmental way.  Thank you.

[lunarlady]

I had PPH with a retained placenta, so eating a piece wasn't an option for me. Cord traction is the main reason I think my PPH was as bad as it was. I would say hands off the cord! If I home birth again, I would do delayed cord clamping, then cut the cord after it stops pulsing, or about 10 min. after the birth. Then a shot of pitocin, coupled with tinctures. If the placenta still isn't coming, some nipple stimulation or nursing to help things along. If still nothing after some time (maybe 40 min) then uterine massage and maybe some gentle traction. Hopefully by that point the placenta will exit my body! I've never had issues after the placenta came, but if I did, I would totally eat a little bit. I've heard about a one inch piece added to a fruit smoothies goes down pretty easy.

[LiLStar]

The circumstances around your PPH should be considered. Sometimes its caused by interventions. If you had pit during labor, it could tire out your uterus so it doesn't clamp down after birth properly. And cord traction can DEFINITELY be a problem. I'd absolutely insist hands off the cord. There are things you can do to minimize your risk of PPH, which is a great idea whether you birth at home or the hospital. making sure your iron is high, eating lots of greens. I made my own "pregnancy tea" with RRL, nettles, and alfalfa, plus hibiscus because its just yummy. I bought the herbs bulk from a local store. 

[Comtessa]

Something to keep in mind re: cord traction and PPH.  I had "no cord traction" wriiten on my birth plan, for this reason, but my MW asked me to reconsider.  She says that gentle, controlled cord traction is sometimes warranted.  I was dubious, but my experience with her tells me to trust her on this point.  What she told me was this: sometimes the center of the placenta will begin to detach on its own, before the sides.  The bleeding, therefore, collects in the space between placenta and uterine wall, and b/c the placenta is only partially detached, the uterus cannot clamp down to slow the bleeding.  A lot of blood can collect in this space, she said, before anyone realizes that the woman is hemorrhaging.  By the time there are other signs of PPH (pallor, fainting, etc.) to clue the HCP's in that there's a problem, the woman may already be in danger from the blood loss.  She said that very gentle cord traction would help prevent this situation by loosening these edges of the placenta enough to allow the blood to flow around it, so that if you're losing a lot of blood the HCP would (theoretically) be able to figure it out and intervene more quickly.  If this is true, I would think it would be even more impotant in a HB setting to trust your MW's instinct on this point. 

Just repeating the advice I was given by my MW -- don't shoot the messenger :)

[AbbieB]

I had a PPH with my first birth. I also had a retained placenta. We handled it all at home.

I was in active labor for 3 days. I am convinced I had a very exhaused uterus. I recieved one dose of pit and some fluids. The bleeding mostly stopped. My MW had to try 4 times to get the placenta out (oh that part suuuuucked!) but once it did all the extra bleeding stopped, my uterus completed it's clamping down and that was that. I decided not to transfer, and my MW closley monitored me for the first week for signs of infection, ect... It took a few weeks to be back on my feet, but I was fine and recovered well.

My second birth was much faster, 12 hours once it got going, and my placenta popped out so soon after birth (like 2 minutes after DS) and my uterus clamped down so well my MW joked it was hard to tell I had just given birth! The highlight of the first few moments after greeting my new baby was DH and I seeing the placenta in the pool, no blood, and high fiving each other that it was all good.

PPH is scarey. I know that my PPH rattled my MW in hindsight. I interviewed a lot of midwives for my second, I can tell you that many seemed reluctant to take me on after hearing I had a PPH. the others seemed a too inexperienced for me to feel good in their hands if it happened again. I ended up going with my origional MW even though I no longer was local for her. I needed a confident attendedent that I had a lot of trust in. The local MWs were not that.