Questions for those of you who had to transfer....

[3cuties]

I am curious about the transfer issue. My midwives have a pretty low rate, about 10% and the majority are due to first time mother exhaustion and wanting pain relief. I am wondering the following quesitons:

If you had to transfer.....

1. Was this your first birth?
2. Was the transfer unexpected? i.e. -- did a similar problem arise in previous births?
3. Was it an emergency transfer or did your HCP provider anticipate a problem?
4. How was the problem discovered?
5. How smoothly or not smoothly did the transfer go -- how did the hospital staff treat you?
6. How lond did the entire transfer process take from the decision time until the actual receiving help/treatment time?
7. What was the additional cost?

[johnsmom]

1. Yes it was my first birth
2. no previous birth to compare
3. Midwife was concerned with fetal heart rate decels, more precautionary than emergency
4. "problem" was ongoing during 7 hours of labour. Midwife was concerned that baby might need breathing help at birth(he didn't)
5. I transfered by ambulance to a hospital where my midwife has priveleges, totally smooth, baby was born 20 minutes after we arrived
6. The decision to transfer was discussed several times over the course of the night. Once I finally agreed things moved quickly. The ambulance was called at 6:30 am and baby was born at 7:26.
7. We don't pay for health care here, so not relevant (Canadian)

[RootBeerFloat]

1. Yes it was my first birth
2. No previous birth, but yes, it was unexpected at the time.
3. Not an emergency. I did not go into labor (no contractions) for more than 36 hours after my water broke. We transfered so that I could get some help moving things along.
4. See above.
5. Very smoothly, though there was alot of role confusion about what my midwife's role was versus the L&D nurse. Everyone seemed uncomfortable to be there, because nobody knew who was doing what, so what wound up happening was nobody did much of anything. Dh didn't know what to do, freaked out, and left the room in tears; I didn't see him again until I started pushing. Literally, nobody talked to me through the whole labor while I sat there and screamed my lungs out, until the OB came in at the end and started barking instructions to me. As arrogant and inconsiderate as he was, it was the most helpful thing that happened the entire time. The moral of this story is to have a discussion with your midwife and partner prior to going into labor about what their roles become in the hospital and what your expectations are of them.
6. We decided to go to a hospital about an hour away from our house because it was in a more midwife friendly community.
7. Out of pocket was $1000, the deductible on our health insurance policy. The hospital charged a $500 emergency delivery fee, which was included with the other charges.

[3cuties]

Tiffany oh my goodness that sounds so stressful! Thank you for sharing.

[MsBlack]

Q. Was this your first birth?
A. No, actually it was my last (6th), after 5 homebirths (3UC)

Q. Was the transfer unexpected? i.e. -- did a similar problem arise in previous births?
A. Yes and no....never had a similar problem before, but the pregnancy had been enormously stressful....really horribly stressful on the partner front...so I can't say it was entirely unexpected!

Q. Was it an emergency transfer or did your HCP provider anticipate a problem?
A. Not really an emergency transfer, tho it was going to become an emergency in time. My HCP--OB providing prenatal monitoring and backup for my intended UC (yes he knew about it)--did not really anticipate anything.

Q. How was the problem discovered?
A. I discovered it during active labor--was bleeding a bit with every contrax, then water broke and was thick with mec. I feared placental abruption from these signs, and turned out to be right, although it was not catastrophic (in early stages due to majorly cord-wrapped baby). I actually labored in the hospital for about 6hrs before calling for surgery, yes, *I* called for surgery, based on my instincts which proved right.

Q. How smoothly or not smoothly did the transfer go -- how did the hospital staff treat you?
A. The transfer went extremely well, but then I had made advance arrangements very well! For instance, my OB mostly practiced at a large regional 'level 3' maternity unit, but also had privileges at a smaller, friendlier local hosp. I told him in advance that if I needed hosp care, I was going to the smaller hospital! He did not like that, but since it did have basic surgical capacity, and was only 5min from the Hi Tech hosp in case 'more' was needed by me/baby, he consented. That way, I had MUCH more control over all decisions about me and baby.

Q. How lond did the entire transfer process take from the decision time until the actual receiving help/treatment time?
A. In my case, since decision to transport was not 'emergent', my helpers drove me to the hospital. First I thought about it for awhile, maybe 1/2 hr or so. Then I got something on (clothes), and into the car. We called hosp to notify I was coming in, had them call the OB. Upon arrival, I was immediately brought up to OB ward, and my doc was there pretty soon. I did continue to labor for some hours with increasingly scary signs (tho OB wasn't jumping for csec, knowing me as he did) before I told him something was definitely wrong and surgery was needed. ANyway, from decision for csec to surgery was about 1/2 hr.

Q. What was the additional cost?
A. Nothing, I was on medicaid.

[guestmama 9918]

I've not had my HBAC yet, but I have a lot of the same questions. Thanks for posting this.

[AllisonK]

Originally Posted by 3cuties

I am curious about the transfer issue. My midwives have a pretty low rate, about 10% and the majority are due to first time mother exhaustion and wanting pain relief. I am wondering the following quesitons:

If you had to transfer.....

Originally Posted by 3cuties

Was this your first birth?

No my third birth but first hbac.

Originally Posted by 3cuties

Was the transfer unexpected? i.e. -- did a similar problem arise in previous births?

very unexpected. no similar problems.

Originally Posted by 3cuties

Was it an emergency transfer or did your HCP provider anticipate a problem?

Emergency for unknown bleeding but not as baby's heart tones were fine the whole time. We drove our own car there with MW taking heart tones the whole way.

Originally Posted by 3cuties

How was the problem discovered?

Gush of blood while in the birth tub.

Originally Posted by 3cuties

How smoothly or not smoothly did the transfer go -- how did the hospital staff treat you?

Very smoothly. They were expecting us as we called ahead to see what doc was on call. I had a choice of three hospitals and chose the one with the most VBAC friendly doc on call. It was actually the furthest away.

Staff treated us kindly. Respected our wishes and let us labor. One PP nurse was a crab. I think it irritated her that we would not let her give DD a bath and that she had not had the eye goop, vit k, or hep b shot. We declined everything and left around 10 hours later.

Originally Posted by 3cuties

How lond did the entire transfer process take from the decision time until the actual receiving help/treatment time?

about 30-45 minutes to leaving the house. 40 or so minute drive to the hospital. Treatment consisted of doc talking to us, doing a VE, getting an IV, and putting on the monitor. I had to be on hands and knees so my MW held it in place the whole time. Doc asked to break my water so he could try and turn Marah who was posterior but I said no I would rather wait a bit.

Originally Posted by 3cuties

What was the additional cost?[/LIST]

No additional cost as my insurance covered everything. But since the insurance was billed for the birth my MW could not also bill for it. We had payed her in advance and hoped to get some of it back once she billed insurance after the birth. But it was not a guarantee to get it back anyway so it would have just been a plus.

[thismama]

Originally Posted by 3cuties

If you had to transfer.....

1. Was this your first birth?

1. Yes.
   
   
   Was the transfer unexpected? i.e. -- did a similar problem arise in previous births?

   N/A as first birth.
   
   
   Was it an emergency transfer or did your HCP provider anticipate a problem?

   It was that my dilation was stalled at 6cm for 7 hours despite strong frequent contractions.
   
   
   How was the problem discovered?

   Cervical checks.
   
   
   How smoothly or not smoothly did the transfer go -- how did the hospital staff treat you?

   It was smooth except that actually physically moving to the hospital in intense labour was a challenge - riding in a vehicle, getting a wheelchair, etc. Hospital staff was good and as midwifery is legal here I was able to keep my midwives as my primary birth attendants.
   
   
   How lond did the entire transfer process take from the decision time until the actual receiving help/treatment time?

   We decided to transfer, then I showered and dressed between contractions, then got out to the car... that was the harder part. Car trip was five minutes, wheeled me into a birthing room at the hospie, then I was labouring in one place again while my DD's father did the paperwork.
   
   Unfortunately then I was subject to hospital procedures, like taking blood, a nurse wanted to do a cervical check which had just been done by the midwife and which I found very painful - my full on labour stalled out for ten minutes til she got called away.
   
   But overall it was a smooth and good procedure, for what it was. I dilated quickly after that and was able to have my baby naturally. Yay!!
   
   
   What was the additional cost?

None as I am in Canada.

[RubyOrganique]

Thanks for starting this thread, 3Cuties. This is my first baby and I too had these questions. We plan to visit the hospital where we would be transferred if non-emergent. It is a hospital that used to back-up a famous free standing birth center in the city and now apparently backs up most of the hb midwives in the city. So I'm less concerned about being treated poorly. My biggest concern with a transfer is the cost. Our midwife has been up front about insurance generally only covering one or the other. We have planned for the $5,500 (!) to cover the midwife's fees in the event we have to pay that out of pocket, but it is still a concern as there will unlikely be a deductible, etc.

I wish I lived in Canada, or France, or Norway where one doesn't have to add this to the list of things to think about.

It's very comforting though to hear transfer stories that turned out alright and where women were respected. Ally'sMom: we'll definitely be having a talk with our midwife after your story-thanks for sharing. We're also going to write a "birth plan" should we be transferred so the hospital staff has some concept of what we're imagining as a meaningful birth. Obviously depending on circumstances, they may not be able to honor everything but it would make me feel better to know we have copies for anyone who wants them and my dh doesn't have to play defense (as much) for me.

Looking forward to more information on this.

[pazerific]

1.Was this your first birth?
yes, it was

2.Was the transfer unexpected? i.e. -- did a similar problem arise in previous births?
totally unexpected, but no other births to base it off of

3.Was it an emergency transfer or did your HCP provider anticipate a problem?
again, no one expected it. it wasn't soooo emergent that we used an ambulance, but we were all a bit worried.

4.How was the problem discovered?
my MWs apprentice was trying to get heart tones on dd and couldn't get any. then my MW tried and was also having trouble. they switched out the batteries a couple times, but it wasn't helping. the heart tones got intermittently stronger and weaker, so the MW left it up to us. when she started setting up a table in case she needed to ressusitate (sp?) dd and got out the oxygen tank, we decided it would be best to transfer.

5.How smoothly or not smoothly did the transfer go -- how did the hospital staff treat you?
the nurse was nice. the doc was rude and gave me multiple lectures about why homebirth was unsafe. also wouldn't let us keep the cord attached until it stopped pulsing because "it could kill our baby" (what a crock). overall it was ok. definitely made me that much more of a homebirth advocate though.

6.How lond did the entire transfer process take from the decision time until the actual receiving help/treatment time?
maybe about 20min trying to figure out what was up with dd's heart tones. then a 5min discussion about the transfer, 10min to get the dogs put away, get me dressed and get a bag thrown together. 10min to the hosp, and they took me right back once we got there. so about 45min total. it definitely could have been quicker, but it didn't need to be.

7.What was the additional cost?
i think our copay was somewhere around $600-$700 for the hosp. dd turned out to be totally fine. i still had a vaginal birth with only pitocin, no pain meds. lots of stitches cause dd had really strange nuchal hand positioning and i tore quite a bit.

[jest]

Was this your first birth? Yes.

Was the transfer unexpected? i.e. -- did a similar problem arise in previous births? I knew that in theory a need to transfer is always possible, but no, I was not expecting it

Was it an emergency transfer or did your HCP provider anticipate a problem? It was not an emergency. My water broke at 1:15am and contractions started within 45 min. Around 8am my midwife checked me and I was fully dilated and baby's head was right there. Around 10am my contractions suddenly started slowing WAY down. I was pushing all day long but the contractions just weren't coming close enough to maintain any progress. Around 8pm my midwife started suggesting a transfer. I knew then that it was inevitable, but it took me another 3 hours to emotionally come to accept it and agreed to transfer.

How was the problem discovered? It was kind of gradual, see above.

How smoothly or not smoothly did the transfer go -- how did the hospital staff treat you? It went pretty smoothly. My midwife stayed with me the whole time as a support person. One of the interns was a little rude to my midwife but as soon as my OB showed up he put an immediate stop to that. He was very respectful to both my midwife and me. The L&D staff was nice to me but the neo-natal doctor & nurse who were in the delivery room were both a**holes.

How lond did the entire transfer process take from the decision time until the actual receiving help/treatment time? I agreed to transfer around 11pm, but we were in no rush because it wasn't an emergency. Instead of just showing up at the nearest hospital, my midwife called my OB/GYN's answering service and he called her back and agreed to meet us at the hospital where he practices, which is about 20 minutes away from my home. By the time I was in the delivery room with my OB there, it was around 12:30. So in my case the transfer took about 1.5 hours, but had it been an emergency we could have just gone straight to the nearest hospital (about 3 min. from my home) and received treatment from whoever was on call.

What was the additional cost? My insurance paid every red cent of the hospital costs. But because of the transfer, my midwife had to itemize her bill to the insurance co. and she couldn't include all of her charges. And then the insurance co. only reimbursed me a small portion of that because they claimed she was out of network (don't get me started). So I ended up not getting reimbursed approx. $2800.

[the_lissa]

Originally Posted by 3cuties

I am curious about the transfer issue. My midwives have a pretty low rate, about 10% and the majority are due to first time mother exhaustion and wanting pain relief. I am wondering the following quesitons:

If you had to transfer.....

1. Was this your first birth?
2. Was the transfer unexpected? i.e. -- did a similar problem arise in previous births?
3. Was it an emergency transfer or did your HCP provider anticipate a problem?
4. How was the problem discovered?
5. How smoothly or not smoothly did the transfer go -- how did the hospital staff treat you?
6. How lond did the entire transfer process take from the decision time until the actual receiving help/treatment time?
7. What was the additional cost?

1. First birth.
2. The transfer was unexpected before labour. I transferred for maternal exhaustion for a long labour.
3. It wasn't an emergency.
4. Long labour.
5. The transfer went well. Midwives can attend hospital births here, so I did not see any hospital personnel until I went to the postpartum ward.
6. 20 minutes.
7. No additional cost. Midwifery, home and hospital births are covered by government health care here.

[Ltlfaery]

Was this your first birth?
Yes


Was the transfer unexpected? i.e. -- did a similar problem arise in previous births?
n/a


Was it an emergency transfer or did your HCP provider anticipate a problem?
it developed over days of labor, not an emergent transfer. DH drove us.

How was the problem discovered?
I was 9.5 cm dilated, with a lip of cervix. the whole time had back labor and had been actively working with the doulas to change DD's position with no luck. Cervix swolle, DD wouldn't budge, we couldn't get her past the pubic bone/cervix. I pushed for several hrs, after a 3 day labor. needless to say, I was dehydrated, exhausted, and ctx remained, but weren't doing much.

At that point, the 'goal' was to get me an epidural so I could sleep, maybe stop ctxs with the epi since fluids alone hadn't worked, and see if DD would turn, my cervix went back down, and I could push baby out. Thanks to hostile staff, none of that happened (including the epidural)


How smoothly or not smoothly did the transfer go -- how did the hospital staff treat you?
Aweful. We went to the closest hospital (the one DH worked at too), and should have stuck to the one I wanted to go to, further away. They were demeaning, unethical, and went to great lenghts to make sure our experience was sh#tty, the fact that my water was broken for over 60 hours was infuriating enough to all of them.


How lond did the entire transfer process take from the decision time until the actual receiving help/treatment time?
that was actually fast...15 min drive, maybe 10 to get to the ward, and they took me into the room immediately.

I was mis-"treated" and tortured for a few hrs before we were cornered into a c/s, and I was too tired to fight anymore at that point.


What was the additional cost?
monetary or emotional?

500 for hospital stay.
200 for pump (DD went to the NICU, I had to pump).
They wanted us to foot the NICU bill too, but I contested and they paid the 5000.



sorry, I' still bitter.
I wish I would have stayed home longer, or gone to the other hospital.


we did have an out of hospital VBAC with DS 3 months ago.

[3cuties]

Ltlfaery I am so sorry to hear about your experience. I would be bitter also. I am so happy for you that you got your VBAC.

[mommy2xman+1]

Was this your first birth? NO

Was the transfer unexpected? i.e. -- did a similar problem arise in previous births? Mine was unexpected, but occured before I actually went into labor.

Was it an emergency transfer or did your HCP provider anticipate a problem? I woke up thinking my water had broke, only to find it was blood and I passed several large clots. Upon calling my midwife, she had me go straight to the hospital and we met there.


How was the problem discovered? see above.

How smoothly or not smoothly did the transfer go -- how did the hospital staff treat you? The hospital staff were pretty well freaked out that I had been planning on a homebirth and seemed on edge and afraid that I would haul my bleeding body OUT of the hospital. The doctor (her back-up) however was WONDERFUL. Although he wasn't able to rule out a placental abruption until after I had delivered, since the bleeding wasn't severe, he allowed me to try an induction instead of taking me right in for a c/s which is what the nursing staff were screaming for. It turned out I had a low-lying placenta, but no abruption. He gave me a hug afterwards and wished me luck with trying for a homebirth the next time (which should be anytime in the next month!) Although I hated the hospital staff, I would transfer back there in a heartbeat if it meant I could have that dr again. He's the one that got to make the final big decisions anyways.

How lond did the entire transfer process take from the decision time until the actual receiving help/treatment time? Since it was from the get go, there were no real glitches with getting in and getting tests run.

What was the additional cost? I do not have maternity coverage and although my complications were listed as covered complications of pregnancy/delivery, they denied all of our appeals, even ignoring the letter the doctor wrote in my defense, so we ended up paying for both the hb and the hospital birth. Sadly this is mostly due to the fact that the doctor spared me a c/s, they wouldn't believe any of the medical documentation since the end result wasn't a c/s like any other dr would have done...