The local hospital has a program, relatively new, called "Stork Doc". This is a specific group of doctors who are willing to work with homebirth transport cases, and they are supportive of midwifery care and natural birth.
Ironically, it is easier to get a "custom" hospital birth transporting from a homebirth, because of this, than it would be planning a hospital birth in the first place.
I'm high risk, in general, due to multiple medical factors, but had two unmedicated vaginal relatively uncomplicated births already, one of them a minimally assisted homebirth. (Midwife was there as backup, did a few things, but was extremely hands-off.) So I planned a homebirth this time with a CPM, plus a perinatologist doing consulting in order to manage some of my specific risk factors.
Two things got in the way of our planned homebirth... first and most important, my son liked to hang out in weird positions. From breech at 36 weeks to a near "neck" presentation at 40 w 5 days, he moved through just about every undeliverable position you can imagine, and never dropped down into the pelvis. His sisters had both dropped down at about 35 weeks and I had a lot of early contractions with both of them. With this baby, he never got down there, so while I had a few bouts of contractions, none of them were 'serious' the way they'd been with his sisters, and thus my cervix was much less ripe than it had been with them, and there was nothing holding him in a decent position. I expect when he's older he'll enjoy jumping on beds more than sleeping in them...
Every time I got close to scheduling a chiropractic appointment, he'd be suddenly seeming to be in a more appropriate position. I was in PT, and knew that I was pretty well aligned, I had visits twice weekly up to about 39 weeks.
The other thing is my physical issues. I have fibromyalgia, and late in my pregnancy, while sick, I damaged a rib, coughing. This was interfering with sleep, and while it improved rapidly when the injury first occurred, it never healed all the way and toward the end started getting worse again.
But we worked hard at home to get contractions going, move the baby to a good position. I spent hours on hands and knees, knee chest, in the deep tub, everything I was physically capable of doing to move a baby without the help of contractions. We even tried eggplant parmigiana (did seem to encourage uterine activity, but nothing serious) and castor oil.
Ironically, not pregnant, I've had IBS and lactose intolerance, and cramping diarrhea is a common complaint for me. But when I went on antibiotics for the cough, I followed them with lactose-specific probiotics, and other probiotics, and suddenly was able to tolerate lactose and other foods that had long given me trouble. So my plot of an ice cream induction was out.
I had one bout of painless diarrhea with the castor oil, 2 stomach cramps, some contractions... but the last three doses of castor oil I tried... not ONE of them actually gave me the runs, let alone contractions. I've never been so annoyed to NOT have cramping diarrhea.
As my due date came and went and my physical condition started to deteriorate, I had my midwife strip my membranes. This gave me my only bout of "serious" contractions... but they only lasted 2 1/2 hours and only served to ripen my cervix a bit. We had her do it again on Sunday, a week after my due date, and days after what I'd always said was my "limit".
Two vigorous bouts of cervical manipulation served to ripen things a bit. But just a little.
I'd had enough, and we decided to go to the hospital and do pitocin. We'd gotten my cervix ripe enough that they wouldn't be tempted to offer cytotec or other such, and we hoped that some good contractions would help shift baby around and let me have him vaginally.
I wrote up a hospital birth plan and emailed it to my midwife, and she called the stork doc, and the doc... said just about everything on my list was fine.
I cried a bit for the change of plans, pulled up my big girl panties, and we went in.
The pitocin was hard and painful, but it was my choice. I labored for 15 hours with pitocin, without pain medication, to get to 7 cm. During that time, we started out with continuous monitoring on belts, but they had a really hard time keeping baby on the strip because he was SO active, so they decided that since his heart tones were so good when they could get them, that intermittent monitoring was okay, and I was able to get rid of the belts. Which dramatically improved my ability to move around. I was able to get in the shower, move as much as I'm physically able to move.
We hit a point where progress was not being made despite horrifically intense back to back contractions, and the doctor determined that baby's head was asynclitic.
I had them turn off the pit and send everyone but my husband and 18 year old daughter out of the room. We discussed options, then had my midwife come back in, and discussed more options. Then we had the doc come in, and explained to her that we wanted to turn the pit back on, work on shifting baby's head, reevaluate in 2 hours, and decide then to continue laboring or do a section.
About 3 hours later, after a combination of pit contractions, spinning babies and traditional Mexican midwifery techniques, the baby's head had shifted and I was a couple centimeters more dilated.
The nurses and my homebirth midwife were my primary labor support during the night, as my family was toast, and the nurses were FANTASTIC. Very supportive, very respectful, I had to actually tell them, no, they did not actually have to ask every time they wanted to take heart tones, or let me know they were about to do it, because it was less distracting for them to just do it than for them to talk to me about it.
The doctor ONLY examined me when asked. She did no interventions without my permission. When baby's head was in a better position, I did let her break my waters, because at that point, going home was not an option.
I hit the wall around 9 am. The contractions, despite a pit level of only 6 (the usual starting dose is 2, and they often go up to 40 or more), were incredibly painful, and I needed to know if progress was being made, because my fibro was flaring hard and I was completely out of energy and out of cope and no longer able to relax or work with the contractions anymore. I knew what I needed to do, but could not make myself do it. I would relax my pelvic floor, and then a moment later it would be locked tight again. I normally have excellent muscle control, but I was so tired in every way that I was not able to maintain relaxation in the face of those brutal, brutal contractions. And every time I went to the bathroom i checked myself and the cervix and baby were staying so high, and I could feel the cervix not even completely effaced... it was disheartening.
So I said, "I need you to check me, because unless I'm dang near pushing, I need to have an epidural or a section, because I don't have enough energy left for transition AND pushing."
I was 7 cm. I'd gotten one more centimeter... in many hours of laboring.
So despite two natural births prior, I asked for an epidural.
The first attempt failed completely.
The second... they did a combination spinal/epidural, for faster relief... and my blood pressure crashed to 50/20. Baby's heart rate was fine throughout, they got meds and fluid into me, blew my IV out, placed a new one, got more meds and fluid into me, and got me stable and back on pit, laboring on my side in bed. It was terrifying.
For a little while, the contractions felt like they went away, but my body was tingly-pins-and-needles-numb, not "absent" numb... I never lost the ability to move my toes, despite my limbs feeling like dead weights. But I'm a very fast processor of 'caine drugs, and feeling started returning quickly.
This turned out to be a good thing, because despite the scare and the less-than-fun level of pain relief... the epidural did its job. The first thing that really broke through... was a deep sense of pressure so intense as to be painful. By 12:30 or 1(I'm guessing), about 2 hours after the epi, I was feeling grunty push urges, sleeping between contractions such as I could, and they noticed I was pushing at about 1:35. They asked to check me to see if it was okay to push, and I told them no, as checking was not going to improve my ability to NOT push, and pushing was definitely not optional.
So I lay on my side and pushed with contractions... still not believing this could end in a vaginal birth, still pretty blindsided by the pain... but completely able to move my legs (to the nurses' surprise) and at about 1:50, I heard the doc say, "Oh look, here comes baby."
That was when I finally got an endorphin hit. Remember that pit tends to interfere with the endorphin feedback loop, this makes contractions MUCH harder and more difficult to deal with. I knew this going in, but baby needed to come out, period.
I asked my husband if he wanted to catch the baby. The doctor said, "I'm just here in case of an emergency," and stood back in the corner while my CPM midwife supported my perineum on the bottom, I supported it on the top, and lying on my side, I pushed my baby out into my husband's waiting hands, without tearing.
No one rushed in to cut the cord. When I told people to step back and give us a minute, they stepped back and gave us five. When they said, "We normally take vitals now" and I said, "He's pink and crying, it can wait," they waited.
When I felt the gush of the placenta start to separate, I had them help me sit up completely, and said, "I want to stand up."
The nurses and doctors, for the first time, blanched and looked at me as if I were crazy.
I said, "Look, I've had feeling back in my legs for ages, you can stand on either side and have someone ready to take the baby, but I know i can stand up and the placenta will come faster if I do."
Skeptical... they helped me stand up. And it wasn't quite ready, so I sat back down again... and a moment later said, "Get ready", and stood without much help at all, and pushed the placenta out into the bag they had ready for it... and my midwife had them set it aside for us to take home later.
The cord was limp and done, and shorter than I wanted to deal with, so we clamped it, and my husband cut it, and I let him hold the baby while I got back on the bed (which involved me walking around the bed). We got ready for our leboyer bath, because baby was still quite agitated at the whole business, and while they were getting the little tubby we'd brought from home ready, I had the doc check my bottom. No tears.
I asked how soon we could go... expecting 12-24 hours.
They said no sooner than 6 hours pending pediatric approval.
That was fine with me. Because we were opting for early release, we never even changed rooms, and baby never had an annoying name tag on his ankle. He was never out of our sight the whole time we were there.
A brief issue about a slight, slight, transient fever (epidural for me + constant skin-to-skin) and lack of early GBS testing meant we had to nudge things a bit, as the on-call ped for our doc wasn't willing to release us early, but the on-call for the hospital was if we did a blood test on the baby for any signs of infection. They had an NICU nurse do the draw, he barely fussed at all, and passed the test with flying colors. We were home less than 8 hours after the birth, with instructions to call the midwife. They even gave us the PKU cards so we could do the PKU at a better time (I have autoimmune hypothyroid and a child with a rare metabolic disorder, this is a screening test we weren't going to skip).
I won't say it was an ideal birth. But given our issues, it happened the way it needed to happen and highlighted how effective it can be to have good transport policies in place to support homebirthing mamas. Knowing the hospital was likely to respect most of our wishes and priorities if we transported made transporting a less terrifying option.
And coming out of a hospital birth feeling respected, feeling like everyone there was on my side? Profoundly healing.
And it would have not been the same birth if I'd started out as a planned hospital birth. it wouldn't have been possible without my midwife.