Natural/home birth after birth defect?

[Sleepymama]

I am wondering if anyone had a similar experience or if any midwives would share their opinions...

I have a 19 month old DS who was born with a severe congenital heart defect and required 2 surgeries, immediate NICU, oxygen, meds, the works. He was born vaginally in hospital after a 22 hour labor and vacuum extraction, episiotomy (he was posterior). We did not know about his heart until after his birth. We have met with a genetic counselor and she told us that our chances of having another baby with a heart defect are only 3-4% and that they would consider me low risk until they found something wrong with the baby's heart (through a 14-15 week u/s and a 22week fetal echocardiogram). She said I could get my regular prenatal care from a midwife if I wanted. I am wondering if any homebirth midwives would take me if both tests showed the baby's heart was fine? I know there is one in my area that has been recommended to me, but I'm not even pregnant yet (though I might be, waiting to test), and my DH is a little leery of homebirth after what we went through. If I deliver in a hospital it will have to be the one where my son had his surgeries, and their L&D is super-interventionist. I have not heard one good story of anyone delivering there. Any advice?

[Jane]

Well, I think the worst case scenario is that there is an undetected heart defect and you deliver at home anyway. What would have happened to your son if his first treatment was oxygen and an ambulance ride to NICU instead of oxygen and a cart ride to NICU? If that scenario is remote or not a problem, than I think the homebirth is an shoo-in.
If the above would be a problem...then you will have to decide your comfort level, maybe with negotiation from dh.
Just my 2 cents.

[wombat]

I had genetic testing, a Level II u/s and an echocardiogram for my dd. I had a brother with a congenital heart defect. I'd ask the perinatologist and the pediatric cardiologist who do the u/s and echocardiogram what their false negative rates are (how often is a baby born with problem that they didn't detect?). We had false positives with my dd and I suspect false positives are more common.

I agree with what Apricot said too. It'll be easier to make your decision once you know how likely an undetected heart defect may be and if's it's crucial to have immediate access to a NICU.

[Sleepymama]

Thanks, I didn't think to ask that. She (perinatologist) said that they could detect anything serious (like my son's) at the level 2 u/s and almost everything more minor would be detected by the echo (as well as better diagnosis). And we have a good relationship with the PC and he'll be the one doing the fetal echo.

I also have heard of more false positives--either there was no defect or it wasn't as serious as the echo showed. My son did not need to be ventilated immediately--thankfully since the hospital where he was born didn't have a level III NICU and couldn't do a vent--and I think an ambulance ride with oxygen would have been OK for him--but I am not sure I would have known something was wrong as well as the nurses & OB & midwife did. Are homebirth midwives able to listen to the heart to detect any murmurs? My Ds's murmur was so loud you could hear it from the back, and from just putting your ear on his chest.

I am just worried that if I deliver in a hospital they'll take the baby away for testing immediately and I'll miss out on bonding again. I guess I could refuse, but I know people whose wishes were not respected at this particular hospital. There is a birth center in my town which would be a good alternative and I'll check them out too.

My Dh is actually more worried about the delivery part since I had such a difficult time pushing him out, and the midwife was adamant about the vacuum because his heartrate was dropping and not coming back up. The midwife almost did the vacuum herself since the OB was in surgery but showed up in time.

I think that anything that would require immediate NICU & oxygen or a vent would be detected by the testing, and if it is more minor and not detected, it will keep until the day after delivery when I will certainly take the baby to the ped and later to the PC for an echo just to be safe. But I will ask about false results numbers for sure.

I just want that first 24 hours, you know?

[lorijds]

I work as a nurse in a Freestanding Birthing Center. We have had several moms in a similar situation to yours have their babies with us.

We typically have the mom do an ultrasound, with her consent of course. We thoroughly discuss how we would handle another defect like that. The parents then decide where their comfort level is.

Good luck!

Lori

[Sleepymama]

Thanks! That is exactly what I wanted to hear. Also, I just found out I am indeed pregnant, due in April. I will be calling around to see what my options are

Thanks again!

[lorijds]

Congratulations!

Lori