Homebirth question, help processing experience

[PGTlatte]

I have a general question about homebirth. I hope it's ok to ask it here. I don't want to ask in the homebirth forum because I don't want to scare anyone.

Basically my question is this.....how much is a baby's heart rate monitored in a home birth ? Especially during pushing ? How common is it to monitor somehow, is it done at all, and how frequently ? And if it is monitored and the baby's heart rate really, really falls, suddenly, what do you do in a homebirth ? And if this happens with no monitoring......what happens then ?

Our second son's birth was physically fast and easy but very very scary. He is 21 months old now. I am still trying to process it. He was born in a hospital, with a midwife, unmedicated. I seriously thought about having a homebirth...because there are so many things we don't like about hospitals....but we didn't, because I found a midwifery group I liked that only does hospital births. My mind keeps going back to the question over and over again, if we had had a homebirth, would he have survived ? For some reason, I need to feel out some answers to this question, so I can get past it. I hope it's ok to ask this here, and that someone won't mind helping with this information.

I had on a monitor belt. I was on my hands and knees so I couldn't see anything. I remember my midwife telling me he was "making the turn". Right after that, I heard her say "call the OB ! call the neonatologist ! the baby's in trouble !" Then she came to my face and told me that the baby was in some trouble, and that he had to come out NOW, and that she needed me to push continuously, with or without contractions, with *everything* I had to get him out. I pushed him out just before the OB came running in.

I flipped over. He was pale gray, the color of old cedar. He was totally limp. He was not trying to breathe at all. I think his first Apgar was a 1. His heart had not stopped. But the way he looked, so pale and gray, so limp, silent....it was terrifying.

DH says his cord was around his shoulder several times. I am guessing it compressed when he came down the last part. The neonatal team resuscitated him. It took a couple of minutes, but he was and is fine. His next Apgar was a 9.

There are many positive things I am thankful for. I think it's wonderful my midwife talked me through pushing him out before the OB even made it to the room, and so there weren't any intrusive emergency measures. I'm also glad we made it to the hospital, and he wasn't born in the van during our mad dash (my labor was very fast), or that I wasn't in a situation in the van where he was crowning with a compressed cord I didn't know about with me trying not to push him out while he died just inside of me. I'm glad I experienced a completely unmedicated birth, that really wasn't that painful or difficult. I'm incredibly glad everything turned out ok, that we have a wonderful healthy son.

I just want to get past the question in my head. If this had been a homebirth, I don't think there would have been a monitor belt. The monitor alerted my midwife to the problem, leading to the actions that saved his life. Is there any way this situation could have turned out well if we had been at home ? Maybe if his heart rate was being monitored with a doppler or something while I was pushing ? Is that ever done in homebirths ?

I know that statistically, homebirth is safe, and that events like our birth are probably pretty rare. I don't know for sure if we are done or not, or if I will have a chance to make a decision about homebirth again. I don't want to be a person who is afraid of homebirth, or who spreads fear about it. I know that most of the time, it is safe. I'm not sure though, after this experience, if I could trust it. The feeling I have is that the monitor possibly saved our son's life, because my birth plan, and my midwife's approach, was that I was only going to push when I felt like it and have a very relaxed pushing stage. The monitor told us differently.

I don't in any way want to harbor negative thoughts about homebirth...I have friends who choose it, and I almost chose it too. I need to get past this question though. Is there any way this could have turned out OK as a homebirth, or are we just very fortunate we chose a hospital for this birth ?

Thank you....

[BirthFree]

I am not a MW and can only tell you my exp. as being a MW assistant. We monitored heartrate every hour and after about every pushing set during pushing (kind of depended). Everyone who was there (myself included) for the care team is cert. for neonatal resucitation (sp? sorry) and oxygen is an arms reach away.

My heart says he would have been ok - but that's guessing from this side of the experience, screen and situation. But with my limited exp., that's my .02.

I'm sorry you had a scary experience - sometimes the reaction the providers have scares the living daylights out of you and doesn't help at all... but I'm very glad your DS responded well and is healthy!

[bobandjess99]

I don't know that there is any way to know for sure what would have happened at home. There *are* a very small percentage of births that are HELPED by being in the hospital. It is certainly possible yours was one of those. Maybe not. I can see the argumant being made that MAYBE, if you were at home, and listening to your body give you signals instead of a belt telling your midwife what was going on, that you *might* have suddenly gotten an irresistable urge to push the baby out RIGHT NOW....I've certainly heard of stories like that. It is also certainly possible that you woudn't have gotten any such urge, the pushing stage might have lasted for another 20 minutes, and the baby might have died on the way out. Again, i don't believe you can ever know for certain.

[angie3096]

Thank you so much for posting this question. I am not a birth professional, I just came here to read, so I don't have the answer to your question. But I am newly pregnant and I also had a scary moment during my labor with my daughter (in a hospital). She is fine but I have these "what if" doubts that make a part of me wonder if homebirth really is the right decision for the next baby. So thanks for bringing it up and I will be watching this thread with interest!

[MsBlack]

I listen every 5-10 min during second stage--depends on the labor, and what I hear. Will listen more often if baby's heartsounds are not reassuring. Might have handled it much the same way, as for telling you to get the baby out NOW--but you would not have heard me yelling for help in that way. I would have kept the energy quieter and not panicky like that, which only makes things worse for everyone including the care providers. Such things do happen sometimes at birth; most often if baby comes fairly quickly (within a few min), then resuscitation can happen just fine at home. With calmer energy and less fuss, the baby might well have started up without the whole shooting match that your baby got--remember, cord compression can happen that way, but once baby is out, cord circulation can resume, and continue for several minutes or even more. Babies are immensely resilient to this kind of stress if it is not too protracted.

Since I wasn't there of course I can't say for sure, but it is quite possible that your baby would have been fine with less adrenaline pumping in the caregivers, and a smaller effort to bring him 'round. Even aside from the physiological factor of cord circulation resuming once pressure was off, we simply cannot underestimate the power of parent's voices and touch on such a baby, and the calm touch of caregivers as well. Few are the hospital caregivers who believe in that power...they believe in their technologies. But I think that just as easily we could say that your baby might not have made it home, it is just as possible that your baby's first breaths and minutes outside of you might have been less traumatic and panicky, and even more rapidly 'righting' for him, had you been at home instead of hospital.

[Reha]

Originally Posted by MsBlack

remember, cord compression can happen that way, but once baby is out, cord circulation can resume, and continue for several minutes or even more. Babies are immensely resilient to this kind of stress if it is not too protracted.

:
Another thing to consider is that in the hospital, the cord is immediatly clamped and cut so the baby can be whisked off to be resuscitated. The vast majority of homebirth midwives will make a point to keep the baby attached to the cord during resuscitation especially....directly after birth, that is the baby's lifeline still, and the baby is continuing to receive oxygen.

[Genesis]

My midwife monitored the heartbeat every so often when I was in labor, and when I was in more active labor she monitered it quite often, and when I was pushing (for hours), she checked it every 10 minutes or so. Any problems with the heartbeat would have for sure been detected at my homebirth.

[pigpokey]

FWIW my UC baby was limp and white at birth -- I was aware that there was not a pulse in the cord b/c I felt for it when the head was born, but I was also aware that it must have been a recent event because he was still moving. I just couldn't get him out until the next contraction. Resuscitation was about three breaths of MTM and he came around. I believe that the placenta probably separated or otherwise gave up the ghost with the contraction that birthed the head. I think that was more likely than cord compression. The cord was skinny and empty when he was born, and the puddle of blood from "separation" was deposited unnoticed by me on the floor when I was kneeling doing MTM.

This event did not make me question home birth, or UC. There are simply a somewhat different sets of adverse events in the hospital or with attendants at home or UC.

[olive&pimiento]

We listen with a doppler every 15 minutes in active labor and after every contraction during the 2nd stage, when mom is pushing. We have caught decels using this method and transfered or hastened delivery accordingly.

ACOG guidelines are every 1/2 during active labor and every 15 minutes during 2nd stage in low risk pregnancies.

[cfiddlinmama]

My preceptor listens regularly during labor and at least every 5 min during pushing. If there is something off with the tones she'll listen more frequently. She and her assistants are all neonatal resuscitation certified. Ms.Black worded it so beautifully I thought. Never underestimate the power of an intact umbilical cord in starting babies! (Though most drs cut it immediately. : )

[pamamidwife]

I typically listen after every other or every third push - the key here is listening AFTER the contraction. Baby's heart rate will drop during the actual pushing, but it should come back up. Also, if mom is pushing on her back that will impact how well baby does, too.

I will tell you one thing: I think that the biggest insult to babies EVERYWHERE is the immediate cord cutting. Babies that have a low APGAR (and who knows if your baby's one minute APGAR would have been higher had any resuscitative measures been done WHILE ATTACHED TO THE CORD!) NEED THEIR UMBILICAL CORD!

Far too many resuscitations are done because of doctor-caused hypoxia (lack of oxygen) through cutting the cord immediately.

It's an insult that rarely happens at home because babies are worked on right in front of mom with the cord attached. The mother's touch and voice is invaluable!!

We all are trained in the same infant resuscitation. However, if babies are resuscitated with the cord intact, there is little long-term measures that need to be taken.

In a healthy baby that is unmedicated, there are typically reserves that will withstand cord compression. We are designed for that type of event perfectly. However, I would never cut off the life support to a baby only so I can hopefully reinstate it artificially later.

[PGTlatte]

Thank you everyone

Since reading the responses, now I can imagine a scenario in my head in which things could still have turned out ok even if we weren't in the hospital, as long as he was being monitored frequently during pushing. I know I could have pushed him out quickly at home, because I did it in the hospital, and he could have been worked on while his cord was still attached. I will never know of course because what's past is past, but I think now I can believe that he could still have been ok. I believe I can move past this fear of what could have happened now.

A note on the births of both our sons...both were in hospitals, both with CNMs. I am very thankful I was with a midwife for both of them. Our first, we were with a large OB practice and you got whoever was on call. He was a scheduled induction that progressed very slowly, and I ended up pushing for almost four hours. I was fortunate enough that the person on call that night was their only CNM, and that I also had a doula. I know that if it had been an OB, and I had not had my doula, there is *no* way I would have been allowed to continue pushing for that long, and that would have been an unecessary C-section for a failed induction, and I am glad it didn't turn out that way. And for our second, with the crisis at the end, I think if I had been with an OB, at the least it would have been an intervention like forceps or suction, and quite possibly it would have been a crash C-section which I might not have even been awake for. Because I was with a midwife, she coached me through getting him out fast myself, and none of those were needed, and I got to participate in saving my baby...which even though it was scary, was very empowering. So again I am thankful for midwifery.

Another thing I learned from this experience..something I read in a Bradley book, that goes against what 911 folks and nurses are supposed to tell you....if I would ever be in a UC situation where the baby is ready to come out, I'm pushing it out, and I won't listen to anyone who tells me not to just because there's no doctor yet or we're not in a hospital. If he had come down in the van on the way there, his only chance would have been for me to deliver him myself. (not that I'm planning anything...I'm not. I'm just saying, this is something I learned from this.)

[madhavi]

my experience at home

i read your last post and i'm so glad to hear you've worked through your fears. but i would like to share my story...well the short version.
2 1/2 years ago i had my first child at home with midwives. my daughter was born after 30 hours of labor, she was blue, limp, breathing was extremely labored. the midwives tried to get her color and breathing but couldn't clear her lungs enough so they called an ambulance. in the mean time i had a 3rd degree tear, i was losing blood, almost passed out, so they called a second ambulance for me. my daughter was in the NICU for 3 days and the doctors were surprised at her quick recovery (we also snuck in lots of essential oils and love). it took me about 3 months to feel normal (down there).. the 1st month my husband had to help me to the bathroom, night and day.
1 1/2 years later, i got pregnant with my son. at first i was conviced to have a hospital birth..but i really didn't want all the interventions etc. so i opted for another home birth. The whole pregnancy i tried to work through all my negative emotions and fears. When i went into labor i told my husband to drive me to the hospital! but of course he didn't. i had 2 midwives a doula and my mom (who's also a trained doula) for support. 6 hours and my little boy was born in the water. breathing healthy beautiful, and my tear was so small i didn't even need stitches! I couldn't have asked for a more beautiful amazing blissful birth.
so what i'm trying to say is, you never know what will happen or how the next birth will be. Just because there was a complication doesn't mean it will happen again. i fully believe that fears can deeply affect complications in birth if not dealt with beforehand. I also think you must have faith in your caregivers, that they will know what to do. and you should discuss your fears with them and ask what they would do in that situation.
I wish you the best of luck!

[PGTlatte]

Thank you for sharing your story ! I'm happy for you that your second birth was smoother than your first.