Info on risk for DH/Parents?

[PretzelBaker]

My DH and parents are tentatively on board for my homebirth but still have concerns about something really bad happening quickly requiring immediate hospital care (we live probably 15 minutes from hospital). It's my understanding that when complications do occur it's usually not something that is hurt by a 15 minute trip to the hospital. But I just can't find any info on it out there. Mainly I find statistics on how homebirth is overal safer/as safe as hospital birth. Does anyone know where I can find something on the different things that can go wrong and how they're dealt with, or something on sudden emergencies? This isn't a pleasant post, but I'd appreciate any help.

thanks,
Libby

[cottonwood]

Your midwife would probably be the best one to answer those questions for you, because she's the one that would be providing the emergency care. But pretty much the only thing they can do for you at the hospital that the midwife can't do for you at home (or during transport) is surgery. And for most hospitals the minimum required time to prep for surgery is half an hour, so if you're 15 minutes away and the midwife makes a call beforehand, you're looking at a similar time frame. And given that at home you're much less likely to need a cesarean in the first place... the risk becomes less, overall.

Do your dh and parents have an specific concerns? I mean, something based in actual knowledge? Or is it just the vague fear that something can go wrong and the belief that hospitals are the safest places to be? I don't know how much time you have, but Henci Goer's The Thinking Woman's Guide to a Better Birth would be excellent for them to read. Rahima Baldwin has a good section on complications in her book Special Delivery, but quite honestly I don't think it would help quell their fears, because so much context is missing. It doesn't talk about the incidence of these problems, preventative measures, or the very real risks of managed hospital birth (most complications, given a healthy mother and an undisturbed labor process, are going to be iatrogenic.)

Here is website with a lot of information about complications (and birth in general) and how they're dealt with in homebirths: http://gentlebirth.org/archives/ There's a lot of information to wade through, and some difference of opinion as well. A lot of maternity care is *not* an exact science. But it may give you some idea of what potential problems could spring up and how some midwives deal with them.

[PretzelBaker]

thanks

Thanks so much for the info! We will talk to the midwife about it at our appointment later this week. I'm glad I have some preliminary info though. I am putting together a packet for my parents explaining it to them.

thanks,
Libby

[georgia]

A pretty up-to-date BMJ abstract

As blueviolet recommended, gentlebirth.org is a wonderful resource. This is a snippet from the site--hope it helps--btw, BMJ is British Medical Journal :

Emergency Cesarean As Accessible for Homebirth As In Hospital

Safe interval for emergency caesarean section is 75 minutes
BMJ* 2004;328 (20 March), doi:10.1136/bmj.328.7441.0

When the decision to deliver by caesarean section is made, time to intervention should be less than 75 minutes to avoid poor maternal and baby
outcomes. Thomas and colleagues (p 665) analysed 17 780 singleton births by caesarean section in Wales and England in 2000. They found that,
compared with deliveries completed within 15 minutes of the decision for an emergency caesarean section, mothers' and babies' outcomes did not differ from deliveries within 75 minutes. Babies delivered after 75 minutes were more likely to have an Apgar score of less than 7, and their mothers were more likely to require special care. Never the less, the target of 30 minutes should remain as the benchmark for service provision, the authors say.
------------------------------------------------------------------------

Women laboring at home within 20 minutes of a hospital operating room have the same access to emergency surgery as women laboring in that same hospital.* Most surgeons are not physically present in the hospital while their clients are laboring; they are either at their office seeing patients, home sleeping in their beds, or simply going about their business.* (Many doctors instruct the nurses not to call them until the baby's head begins to crown.)* Whether an emergency arises at home or in the hospital, it still takes time for the surgeons to be paged, to drive to the hospital and to arrive at the scrub sinks.* It takes time to assemble the anesthesiologists, nursing staff and neonatal teams necessary for a cesarean section.* Hospitals offering labor and delivery services must be able to start cesarean surgery within 30 minutes of being notified of the need, which gives women laboring at home plenty of time to get to the operating room ahead of the surgeon.

How can this be safe?* Childbirth "emergencies" usually develop over the course of hours rather than minutes, especially when they're not actively caused by interventions such as artificial rupture of membranes, administration of pitocin, spinal/epidural anesthesia or pulling on the umbilical cord to deliver the placenta.
------------------------------------------------------------------------

What is a reasonable time from decision-to-delivery by caesarean section?* Evidence from 415 deliveries shows that fewer than 40% intrapartum deliveries by caesarean section for fetal distress were achieved within 30 minutes of the decision, despite that being the unit standard.
------------------------------------------------------------------------

Two papers and an editorial in this week's BMJ describe the difficulties in meeting the target of 30 minutes between the decision that an urgent caesarean section is necessary and delivering the baby.* [May, 2001]

Interval between decision and delivery by caesarean section -- are current standards achievable? Observational case series
"Conclusions: The current recommendations for the interval between decision and delivery are not being achieved in routine practice. Failure to
meet the recommendations does not seem to increase neonatal morbidity. "

[georgia]

True obstetric emergencies are really rare. The great thing is that many times, there are warning signs WAY before things get to the emergency state. Not to be a bummer, but, unfortunately, even when you're in the hospital, those emergencies can occur, and sometimes, no intervention in the world can fix it. Technology is only a tool not a cure-all. Ok, back to happy homebirth thoughts

[anothermama]

Early in my pregnancy, my DH went on a business trip and I sent him with Heci Goers "Thinking Womans Guide to a Better Birth".........which convinced him by the time he got home. I just make sure to put all the books I read under his nose as well...........Ina Mays Guide to Childbirth he REALLY got into.