Birthing Center concern/question

[Celticqueen]

I want to birth in a birthing center for the reasons of an epidural not being available as an option (i.e.- even if I scream for it, they can't give it , a more comfortable, calm, friendly atmostphere to bring children into the world, etc. But my dh and my only concern is this:

What if it turns out that the baby is breech, or the heartrate plummits, or (other emergencies) and a c-section is the best option? Are there C-section
surgeons on call at birthing centers to perform them in case of
emergency? If there is, we will most likely go to a birth center next
time around. I tried researching this online and couldn't find
anything about it on birth center websites, which concerns me.

Thanks in advance for information!

[alegna]

You would transfer to a hospital. Same as if you were at home.

-Angela

[Celticqueen]

Originally Posted by alegna

You would transfer to a hospital. Same as if you were at home.

-Angela

Hmm, but I wonder, what if it turns out to be too late? Would I be rushed in an ambulance or...?

[alegna]

Do some more research. Out of hospital birth is very safe. Safer than IN the hospital for low-risk moms.

-Angela

[Quindin]

Originally Posted by Mommyofwills

Hmm, but I wonder, what if it turns out to be too late? Would I be rushed in an ambulance or...?

In my birth center it depended on the complication really. For some non-urgent things they had your husband drive, and for urgent things they would call an ambulance

I had a FANTASTIC birth center experience last time - I HIGHLY recommend it! It helped DH and I realize that births really don't need all that fuzz and that for us it actually made it all much easier. That's why we're having a homebirth next time

Quite frankly, many of the "complications" and "life or death" scenarios painted by hospitals are not really that. They often seem to pain things uglier than they are in order to speed up things. I would not worry at all!

[Individuation]

OP, I just want to let you know that I was booked to deliver at a birthing center, and in my fifth month one of the midwives there said "You know, I think you and your husband really want a homebirth, and maybe you should be trying to make that happen."

I mentioned my husband's concerns that the BC was "safer," and she told us that they had NOTHING in the BC that we couldn't have at home with a CNM--a bed, oxygen, clotting drugs, and a nearby hospital in case of emergency. Also, at home I had much less chance of infection (my own germs and such). We're now planning a homebirth and I'm much happier.

In either case, a hospital transport would be the same, as Alegna said.

[pamamidwife]

Well, in our area, all the freestanding birth centers are run by homebirth midwives. This means that there is nothing at the birth center that the mw doesn't bring to your home....so staying at home could mean you'd be closer to a hospital in the event of transfer.

Angela is right: out of hospital birth has a proven safety record. The thing about it is this: in home or birth center births, there are fewer interventions, no medications, more autonomy for mom - so this results in less dire emergencies (no fetal distress caused by interventions or meds). In 99.5% of all transports I've had, they've been non-emergent from home. We go in a private car.

If it was a serious issue, ambulance to the closest facility would be warranted. This is another thing to consider: where is the closest facility to the birth center? The availability of emergency services? Traffic?

Serious complications are much more rare at home or birth center than in the hospital purely for the reasons listed above. We also only deal with normal, low-risk women. Of course, serious complications can arise - but so can getting in to a car accident on the way to the birth center or hospital. Nothing is out of the realm of possibility - you just have to feel comfortable with the risks of either.

Here's more information on the safety of homebirth: http://www.midwifemama.com/homebirth.htm

[ckhagen]

I guess it depends on what kind of "birth center" you're talking about.
If they don't offer an epidural, then I'm going to assume you're talking about a free-standing/midwife owned birth center. In that case, if something happens you'll be transferred to the hospital. Most birth centers are pretty close to hospitals (I think mine was 3 or 4 miles).

First of all, most midwives can see an emergency coming long before it's an emergency. So there are very few things that could happen that would be so emergent that you couldn't get there in time and if those things were to be an issue, even being inside the hospital couldn't get you there fast enough.

At our local hospital, it takes about 28 minutes from call to cut for an emergency c-section! Well... it doesn't matter whether those 28 minutes are spent in the car/ambulance getting to the hospital or sitting in the hospital bed waiting for them to get it together.

[courtenay_e]

Generally, at a hospital (around here, anyway) the saying about a cesarean is that they want it to be "30 minutes from decision to incision." Usually babies DON'T just randomly die. They show signs of stress. They give us time to react. So if it looks like a baby or a mom need to be transferred, it'll depend on the severity of the situation if the midwife waits for an ambulance or they just put her in the car and drive. Generally, with a backup, or a hospital that knows that the birth center is there, and is used to taking their transfers, you'll have a cesarean more quickly transferring in than you would being on the unit and waiting there.

[courtenay_e]

[QUOTE=polihaupt;8470870Quite frankly, many of the "complications" and "life or death" scenarios painted by hospitals are not really that. They often seem to pain things uglier than they are in order to speed up things. I would not worry at all![/QUOTE]


I agree with this, too. I have conversations with my clients about doctors and staff who play the "dead baby" card in non-emergent situations. Generally our conversation ends with the parents coming to the conclusion that, if it were TRUELY an emergent situation, the doc would be wheeling the bed as fast as his feet could take him into the OR, not talking about pitocin or exteral fetal monitoring as an avenue to saving a baby's life. Just a thought.

[Celticqueen]

Interesting info everyone. Thank you. I'm not even pregnant with #2 so I still have a ways go go but I want to be educated on my options.

[lramom]

My BC was within a couple of miles of a high level hospital. I didn't end up being able to deliver there, because my son was a preemie . But, in case of emergency, they would have called 911 to transport. If it was just failure to progress and the mom wanted to go, or some other non-emergent reason for transfer, the birth partner (if there was one) would transport with the midwife following in her car or (if there was no partner), the medwife would drive the mom.

According to them, emergency transfer was so rare there as so be almost nonexistent, especially during labor. Occaisionally there were emergency transfers after labor (mom won't stop bleeding, baby having trouble, etc). Most of those, though, the midwives were completely trained to deal with in the short term until transfer.

[Celticqueen]

I'm still a bit concerned, but less concerned now. I will let my husband know about these answers to see what he thinks.

[Celticqueen]

Originally Posted by ckhagen

I guess it depends on what kind of "birth center" you're talking about.
If they don't offer an epidural, then I'm going to assume you're talking about a free-standing/midwife owned birth center. In that case, if something happens you'll be transferred to the hospital. Most birth centers are pretty close to hospitals (I think mine was 3 or 4 miles).

First of all, most midwives can see an emergency coming long before it's an emergency. So there are very few things that could happen that would be so emergent that you couldn't get there in time and if those things were to be an issue, even being inside the hospital couldn't get you there fast enough.

At our local hospital, it takes about 28 minutes from call to cut for an emergency c-section! Well... it doesn't matter whether those 28 minutes are spent in the car/ambulance getting to the hospital or sitting in the hospital bed waiting for them to get it together.

Yes, the one near my home is a free-standing birth center. Not offering epidurals (awesome) I can imagine me screaming for one and them saying, "Sorry, we don't have any" and I'd then have to deal with it. I like that.

[mwherbs]

at best it is 30 minutes from decision to incision-- but there is a trick to that, a nurse does not make that kind of diagnosis or make the decision so it isn't from incident to incision-- it is from when someone/(doctor) is present and makes the call(decision)
there is an interesting study from and Oregon hospital that looked at AROM and cord prolapse, that they were causing a problem that they had to solve and not always meeting the mark...

[Quindin]

Originally Posted by Mommyofwills

Yes, the one near my home is a free-standing birth center. Not offering epidurals (awesome) I can imagine me screaming for one and them saying, "Sorry, we don't have any" and I'd then have to deal with it. I like that.

That's exactly what happened when I gave birth to my frist at age 20
I remember feeling so angry at that moment Of course, afterwards I felt extremely blessed and thankful that no intervention or meds were provided!

[Belleweather]

Our birth center was run by an CNM, and she required us to register at the hospital of our choice in case of an emergency, which I guess cuts the time down signficantly because they've already got all your billing information. We'd only be transported if there was an emergency in labor (in which case we'd go by ambulence and they actually had cool special doors for ease and privacy just in case) but if it were for faliure to progress or pain medicine we'd go in our car.

For stuff like twins, or a breech presentation or some other problem they'd pretty much know before labor and we'd work to transfer care to one of the doctors that deliver at our hospital. Our midwife has been around long enough to know which ones would be open to a more natural birth, so she'd recommend someone and would stay and doula for us in labor.

[liawbh]

Even birthing in a hospital could require transfer for the baby. We had to call the neonatal ambulance crew for my 2nd from the birth center, but that would have been true at most hospitals also, becasue he needed the higher level NICU care.

You can check with your local birth center, and homebirth midwives, and find out what the transfer rates and emergency C-section rates are. They are usually incredibly low. THose statistics helped convince my dh that we didn't need hospital birth.