Unplanned Homebirth - What could I have done differently?

[halo8]

I am somewhat obsessing about how the birth of my second child happened and wanted to see what the professionals and experienced moms here thought.

My second DD was due October 31st - ish. I am sure of my dates but u/s had dated my baby a bit earlier - Oct 22nd. Doc wanted to induce, I decided not to, but on Oct. 23 she stripped my membranes while doing an internal exam. Late that night, about 11:00 pm I started feeling contractions but wasn't sure it was actually labour. At midnite, i decided to start timing to see where I was. All of a sudden, they were coming on top of each other and I was sitting on my knees on the floor with my arms supporting me on top of my living room couch. I just suddenly felt I had to push. Then my water broke and we thought - this baby is going to be born here, call the ambulance. The ambulance arrived at 12:30 and baby was born at 12:45.

The birth itself was amazing for me and my husband! I did it, without drugs, exactly as I wished to. My husband was right there and she was born in 1 hour 45 min. from start to finish.

however, after the baby was finally born, it seemed to me that the paramedics took too long to get baby wrapped up and warm. She was very blue and didn't cry very much. She was on my living room floor for what seemed like forever but was probably about 5 minutes or so. Then we both were transported to hospital. There, she was transferred to the NICU (where we spent 10 days). There was fluid in her lungs -- they tell me because she came so fast and didn't have time to transition - is that what happens in your experience? and she needed oxygen for about 8 days. They had her on IV and antibiotics for several days but there was no infection in the long run. They did a cardiac ultrasound and cranial u/s b/c they had found a heart murmer but all seems to be fine now. The doctor lastly told me that he thinks she may have actually been a bit early and that sometimes with gestational diabetes like I had, the ultrasounds are wrong when it comes to dating. Like I always thought!

I guess what I am wondering is how much of this do you think is due to the fact that she was born as quickly as she was, because of the stripping of the membranes and because of not being kept warm right after birth. If I had not had the induction intervention, and if she had been in the hospital when she was born, or if I could have had a planned homebirth, with a midwife present, would/could any of these problems have been prevented? Thanks for your advice.

[rabbitmum]

I'm not a professional, but I have also had an unplanned homebirth. My second child (first son) was born spontaneously one day before my due date. I didn't have - or didn't feel, or understand that I was feeling - contractions, but went straight to pushing. He was born in two pushes - it was great!

I was in my bathtub when he was born, and I held him there for a while, but as it took a while (45 minutes) for the ambulance to arrive, I went and lay in bed with him under the duvet. He didn't cry very much either, but none of my babies have cried much at birth, so I don't know whether this had anything to do with him being cold - which he was, when we finally arrived at the hospital he was put in a warm box for a little while to get a better temperature. He was not blue when he was born, but my daughter was, even though she was born in a hospital, so I don't know if the blue colour is associated with being cold. (And she was fine, even though I was a bit scared when I saw how blue she was.) My homebirthed son did not have fluid in his lungs, even though he was born very fast. He didn't need any special care apart from the 30 minutes or so in the warm box.

I don't know if it's possible to deduce from this that none of the symptoms your daughter experienced was caused by the quick birth and being cold. Maybe it depends a bit how cold she was? My son was about 35 degrees centigrade - I don't know what that is in your temperature scale. And he didn't have any trouble because he was born at home without anybody than me to catch him. To me it sounds like your daughter was probably simply a bit early. Was it because of gestational diabetes that your doctor wanted to induce, and stripped the membranes?

[Alison Cole]

In my limited experience (anyone else have ideas?), stripping membranes is more of a nudge toward labor, rather than an induction. If your body is heading that way, stripping the membranes may help it there. But I've seen ladies who desperately wanted to get their babies out who had their membranes stripped at every visit for weeks with no luck. Also, at the birth center where I'm learning, births between 37 and 42 weeks are considered totally normal and full-term. So Oct 22nd vs Oct 31st doesn't seem like a huge amount of difference. In most cases, my sense would be that there's no reason to change a well-confirmed due date based on an ultrasound, but a baby could come 9 days before being due and in most cases have no problems. I have heard of/seen babies born fast have a harder time clearing their lungs, but I have also seen babies who were born fast with no problems. I wish the paramedics would have handed you your baby rather than leaving her on the floor, but I can't say that that necessarily contributed to her wet lungs. Could be this would have happened no matter where you had her, or it could be things would have been different if there was a trained birth attendant around, because I don't know that I'd count the paramedics as "trained birth attendants", since they are more trained to deal with medical emergencies than normal births. I'm so sorry she had to spend so long in the NICU. But it does sound like a pretty amazing birth experience, and it also sounds like she's going to be okay. I think some times (at least in certain places) hospitals tend to really scrutinize babies that transfer from an out of hospital setting, and maybe this could have played a part in the docs thinking she needed antibiotics and having concern about the heart murmur which eventually went away. I hope you find some peace with this birth, and congratulations on your newest family member!

[halo8]

yes, it's because of GD that the doc wanted to induce. I let her strip the membranes because i was set for induction on the 29th (I had put off the doc for a week, but felt guilty trying to go longer than one week "overdue" and I thought that was the lesser of two evils. I also thought that if my body wasn't ready, it wouldn't work.

I, too, wish the paramedics had let me hold her. (one thing I would have done differently - would have demanded it!) They actually told me to not even turn around after she was born (which I eventually did) it was their first birth, so I gotta cut them some slack - they looked more scared than me. I think they might have been trying to figure out what to do next. There were actually four of them and one did everything while the other three stood around with their mouths open

I do think the hospital "overscruitinized" for sure. I was so excited about my home birth and the staff kept saying things like "Well, maybe if you had been here in the hospital...." as if they were very disapproving. They told me if I decided to have another one, I should camp out on the hospital lawn for the last month.

And you are right - she is going to be fine (mom may take a bit longer to be okay, lol. I still worry about her going into apnea at nights) and everything turned out as well as it could.

[rajahkat]

wow.

I'm trying to get over my amazement that the paramedics wouldn't " let" you hold your baby. Babies need to be kept warm. If you hadn't had the paramedics (who had never attended a birth before, and didn't know she should be kept warm?!?!) telling you what you should be doing, you most likely would have naturally picked up your baby and kept her warm.

What could you have done differently? Well, know that for the most part, when birth happens THAT quickly, it tends to happen smoothly and without problems.

The hospital scenario that played out sounds like what I've typically seen happen when an unexpected homebirth happens. "Most likely" none of it was needed. Oxygen for 8 days? Was she not breathing when she arrived at the hospital? Antibiotics? For what? Probably to counteract the hospital acquired infection she has a frightening chance of contracting in the NICU.

Yes, the fluid in her lungs might be because she was born so quickly. But I doubt seriously it needed the aggressive treatment she received. I really don't know what to say. Yes, it probably all could have been avoided by being in the hospital or by having planned a homebirth with a midwife. But really, even if you had planned a midwife attended birth, she most likely wouldn't have made it in time. It probably could have been avoided by not calling the paramedics to begin with, and taking the baby to a doctor to get checked out if you felt the need.

She couldn't have been having that much trouble breathing if the paramedics left her on your floor for 5 minutes right?

Yikes. I doubt I've been helpful at all. I'm just sorry to read about your experience, and I'm glad your little girl is doing well now.

Kat

[halo8]

OM goodness - you've kinda said all the things i had thought about. If the paramedics hadn't been t here, i definately would have snuggled her immediately!

She was definately breathing when we got to hospital, but they put her on oxygen right away. They said her saturation was low. Then that when she went into deep sleep at night, she forgot to breathe for a bit. They also said she came out of it by herself each time though.

They gave her antibiotics, as far as I can tell, just in case there was a respiratory infection. They do a culture then check it at 24, 48 and 72 hours and after 72 hours they decided she did not have an infection. I never really understood it and even though I asked questions, the answers were very vague to me.

In hindsight, I wish I hadn't called the paramedics, but honestly, I was scared because I didn't know that I was so close to giving birth - I thought I maybe still had 10 or more hours of hard labour in front of me, and didn't recognize things as already being in transition. If I had known I only had half an hour or so to go, I wouldn't have been so afraid.

[rajahkat]

No kidding you were scared! Don't blame yourself, we can waste A LOT of time thinking about what we should have/could have/would have done. You made the best decision you could given your plans for (I'm assuming?) birthing at the hospital with plenty of time for getting there.

Don't sweat it, mama! Just have a plan in place for next time should you happen to go that fast again! I'm assuming the paramedics cut the cord immediately? Try to remember that if you find yourself in that situation again, leave the cord alone. As long as it's pulsing, and you're breathing, your baby is getting oxygen through you. Then if your baby IS a bit slow to transition to breathing on his own, you've got a bit of time to let him come around. You don't have that if you've just severed his life support.

I'm wondering how much your baby's low oxygen saturation is related to her cord being cut and her being allowed to get chilled and kept separated from you. And the apnea episodes were thought to be related to possible prematurity?

Anyway, take care of yourself and enjoy your baby girl!
Kat

[MyBoysBlue]

's to you, fellow Albertan. I know that kind of labour. Both my boys were born quickly, DS1 2.5H and DS2 25Mins. My labour starting in transition both times. I had a UC with the second specifically because I knew it would be quick and I didn't have the option of a midwife. Probably would have UC'ed anyway but that is another story.

I agree with everyone that the paramedics not letting you hold your baby and keep her warm may have caused some of the problems. But it is really hard to say. I personally doubt that the Antibiotics were needed but that is JMO and I wasn't there. I just want to say be prepared for a quick labour again if you have anymore kids.

[rabbitmum]

"My" paramedics didn't have a clue either. They looked very confused and even looked like they were scared of our little rabbit that was jumping about! But there was also a midwife who came with them, and she cut the cord and held my son while the paramedics strapped me to a stretcher (despite my protests) and maneuvered me rather bumpily and uncomfortably down the three narrow stairs to the ambulance. My son's father and my daughter were both in the back of the ambulance with us, so it was a fun (but very uncomfortable) ride!

When I was expecting my next baby, we received a quick UC course from a doctor at the hospital. She said the important things were:
1. put lots of towels or something soft on the floor
2. the father must hold his hand on the baby's head to gently prevent it from emerging too quickly and cause tearing
3. leave the cord alone
4. keep the baby and mother warm
5. call the hospital, they would send a midwife straight away.

Actually I ended up having my waters broken at term because I was so stressed out by thinking that the baby was to pop out any second in any random place. And it took four and a half hours this time.

[halo8]

Oh, rabbitmum, I understand that look of confusion in the paramedics! It sounds exactly what it was like at my house. It was actually almost funny....almost!

Were you alone when you gave birth to your first son? As much as I like the idea of doing it alone, I think I would have been afraid. But just me and my hubby, that would be my ideal.

Did I mention there are NO midwives in Grande Prairie? (as you probably know MyBoysBlue - I think there are like, 4 in all of alberta!)

[rabbitmum]

Originally Posted by halo8

Oh, rabbitmum, I understand that look of confusion in the paramedics! It sounds exactly what it was like at my house. It was actually almost funny....almost!

Were you alone when you gave birth to your first son? As much as I like the idea of doing it alone, I think I would have been afraid. But just me and my hubby, that would be my ideal.

Did I mention there are NO midwives in Grande Prairie? (as you probably know MyBoysBlue - I think there are like, 4 in all of alberta!)

He he! Yes, it was funny, and the whole experience was just great! I felt really... empowered!

Do you have a rabbit too?

I was not really alone in the house, but my partner was on the phone and my daughter was asleep, so I was alone in the bathroom (having a bath). I wasn't afraid, since I was completely absorbed in what was going on (pushing! ) and everything happened so fast that I didn't have time to think very much anyway.

The only reason I wouldn't have chosen the same set-up for my third birth is that I bled so much after my first, and I would have been worried about that happening again.

In Norway there are midwives at all the hospitals, and births are attended by midwives, not doctors. The doctors only come running if something unusual happens, which is not really that often. So a hospital birth here is not the same as in the U.S., as they usually don't intervene so much. Therefore it's not seen as such a big advantage to have a homebirth here, and it's not very usual. I don't know anybody else here who have had one - and I didn't plan one either!

But having your baby at home, yourself and nobody else being in control, undisturbed by strangers, is really special!