distance from hospital a concern?

[sahm]

I am thinking about doing a homebirth for our next child. I delivered my 13 month old at a hospital with a traditional OB with no complications. I'm young (25) and healthy and am a pretty good candidate for a homebirth. Also, there are several things I would like to do differently at my next birth that I'm don't think would occur with a traditionaly OB. However, we live half an hour from a hospital and I guess that's my only concern. I know that probably nothing will go wrong, but there's always that "what if" in the back of my mind. If something were to ever happen to my baby because I chose a homebirth and was unable to get any emergency intervention (if necessary) I just know that I could never live with myself. But I REALLY do believe that birth is a natural process and really want to do it naturally at home with no interventions. Anyone else deliver at home at a distance from a hospital? Can you give me some input or reassurance? Is there anyone out there who had a homebirth with a negative outcome that would not have occured with a hospital birth? Are there many scenarios where I would need emergency intervention where half an hour away would be too big of a distance? I am just really wanting to think this through very thoroughly and would welcome anyone's input.

[LizD]

Half an hour doesn't seem that far to me, though of course you need to talk with your caregiver about what complications he or she might foresee arising. They're probably the best person to put your mind at ease, esp since you'll be in their hands should god forbid something go "wrong." But the common complications, like hemmorhage and a slow-to-start baby, well, the midwife or doctor brings methergine and oxygen, and these things as well as resuscitation techniques can be given en route to ER as well as at home. Things such as dystocia or surprise breech- you need to ask your caregiver for an honest assessment of their experience and skill because these are potentially serious complications. If they do not have the skill you might be better off being closer to a hospital, say if you have someone to stay with. I am also planning a homebirth for a second child- first in birth center totally normal- and I don't anticipate anything going wrong, but I must admit that is easy to do when the maternity hospital is four miles away, and an ER only two miles away. When all is said and done it is the unique combination of your pregnancy, health, confidence and the expertise of your attendants that has to decide this question.

[OneTrickPony]

I'm going to second the opinion that half an hour doesn't sound that bad to me. I live around the corner from a hospital with a neo-natal intensive care unit - I know that lots of babies born at other hospitals come to this hospital from more than half an hour away. (That is, these aren't home births - and the babies are brought here from more than half an hour away!)

It seems to me that once you get started on the "something could go wrong and I need to take precautions" road, it's hard to get off. So all those babies born in hospitals with no neo-natal ICU - should they all be having their babies in my local hospital? Should everyone be attended by not only doctors but pediatric surgeons *just in case*?

I recognize that your children's health is your first priority - but I think as women we are also entitled to take control of our birth experiences. And the reality is that we don't live our lives, generally speaking, constantly thinking about the small chance that "something could go wrong." (September 11 really pointed that out to me!)

Take heart that the hospital is there and available to you *if* you need it. I think having the birth experience you choose will translate into a happier mama and a less stressful labour and therefore *less* chance that something will go wrong!

I hope this post makes sense!

[jordmoder]

I was part of a rural practice where our transfer hospital was pretty much a 1/2 hour away from anywhere. That 1/2 hour distance was our policy - farther than that we encouraged women to come in to our freestanding birth center, which was in the town the hospital was located.

Earlier posts are absolutely right - usually there are signs if things aren't going right, and only in a true emergency beyond the capabilities of the home midwife is time of an essence.

It's always a good idea to talk over the transfer policy with your midwife long before labor/birth and get a plan worked out. Under what circumstances would you transfer to a hospital, how would you get there, what happens after you get there, etc.

In over 300 births, the only true emergency I was ever involved in happened to me - and nothing would have made any difference.

Barbara

[rainsmom]

an hour away

I planned for a homebirth. I labored at home in a tub for 14 hours, then transported (at 10 cm)(!) an hour away to a hospital. Dont ask me how I did it......lots of breathing, AND I didnt want to birth in our new car!!! power of the mind i guess. It was another 3 hours before she came. Her head wouldnt turn.

[indigolilybear]

you might feel better after reading "emergency childbirth" by...shoot forgot his name..I wanna say gregory white?,..anyway, he's an MD. Many freebirthers recommend it cuz it has simple directions for emergency personnel. THis was a very comforting book for me as we planned our first freebirth. his basic thing is that if a baby is in distress, there's not taht much you can do for it and if the mama is (as in hemoraging which your midwife will probably have pitocin for anyway) that a study showed that no mothers died before 2 hours after the birth meaning you'd have 2 hours. anyway, his straightforward advice really comforted me that the body is best at doing it's work and we just need to stay out of teh way and that probably no one was going to die. Sounds weird, but thought these thoughts might comfort you. and an aside, there is always risk anywhere...birth is a safe as life gets right?? good luck

[organicmama]

I am a labor & delivery nurse by profession...a SAHM by choice. I am planning a home/waterbirth this June with baby number 3. My last baby would have been a homebirth but we lived about 45 minutes away from the hospital. I believe the legal standard of care is that a baby must be delivered within 30 minutes once a life-threatening emergency is determined. You are 30 minutes away from the hospital but I doubt it would take you that long to get there if it was a true emergency! The midwife would call ahead & they could be ready for your arrival. It takes time anyway to locate the doctor, anethesiologist, set up the OR suite, etc. for a ceasarean. There probably wouldn't be much difference in time lapse. Anyway, that's how I rationalize the risk in my own mind.

I should add, I believe it's very unlikely to come to that anyway. Complications are usually picked up before there is a true emergency. In spite of all I know about what can go wrong, I am very comfortable with my decision to homebirth.