cord prolapse,meconium, what other reasons would i be transferred to hospital from homebirth?

[contactmaya]

Hi everyone,
im due in a few weeks and am really excited about doing a homebirth. My mother, however doesnt support it.

I want to know what kind of things could arise, where i would have to go to the hospital to save the baby. I want to know in these scenarios, how much time i would have. From what ive read, you usually have enough time to get to the hopsital, or the mw can perform a life saving procedure at home. But i cant find enough information about all the things that could go wrong. I only know about cord prolapse, meconium, and malpositioning.

Can anyone tell me what could go wrong for the baby in an otherwise normal pregnancy? i cant seem to find this information anywhere.

I am optimiistic about everything, but i would feel more empowered if i had a detailed idea of what could go wrong....

Thanks for any useful information.

Maya

[RachelSerena]

I transferred for meconium for my last baby.

The only other thing I could think of would be bleeding before the baby is born (placental site, etc.)

But, I'm not a birth professional. Someone else can be of more help.

[JamieCatheryn]

Heartbeat deceleration indicating distress might mean a transfer. Placental abruption, if it seriously detaches and bleeds you'd go to c/s in the hospital right away. Uterine rupture is rare but that's another reason for rushing to a c/sec. Hemmorrhage after the birth that the mw's efforts didn't fix would mean a transfer, say if there was retained placenta causing it. A very large tear might mean hospital transfer also.

[delicious]

i think i read somewhere that one of the main reasons women end up transferring from home to hospital is exhaustion/dehydration. but if i made that up, someone tell me.

[clutterbug]

Originally Posted by delicious

i think i read somewhere that one of the main reasons women end up transferring from home to hospital is exhaustion/dehydration. but if i made that up, someone tell me.

My midwife (and also the other midwife I interviewed) both said that the vast, vast majority of their transfers are for exhaustion or because the mom really wants to have pain relief. That said, of course there are emergencies that require a transfer...but many transfers aren't really to save the baby per se.

[EmmetnLindley]

My midwife had told me that all of her transfers were due to needing more pain management that could be provided at home. I transferred after 50 hours in labour due to malpositioning. He was stuck and not coming out!

[nurturedbirth]

Also, postpartum issues: excessive bleeding, retained placenta, a baby that isn't maintaining vital signs in optimal ranges or that required resuscitation. Some of those would obviously be transfer of the baby rather than the mother.

[contactmaya]

Hi,
thanks for your replies!

Placental abruption-i didnt have it last time with pitocin back in 2005with my first born, so i dont see why i would have it now. Apparently being over 35 is a risk factor for this (googled it) I'm not really sure why, but it doesnt worry me. (i guess us oldies dont make such strong placentas ;-)

Meconium though is an issue for me. My first born (now 31m) was overdue. It is likely this one will be too. there is more likely to be meconium in this case. every second person i meet had meconium issues. I know statistically it is uncommon, but anecdotally, it doesnt seem so. I suspect hospital intervention (such as induction) contribute to this. But what if my 'overdue' baby has meconium? can the midwife clear it at home, or do we need to rush to the hospistal?

Rachelserena-what happened with meconium in your case?

And fetal distress- doesnt just being born in itself cause fetal distress. how do they know when 'fetal distress' requires hospital transfer? Is it less likely to be the case if labor progresses quickly?

As for maternal complications-im not too worried, after all, if there was bleeding, surely there would be time to save my life. As for tears, i am sure that being able to move around (as opposed to being stuck to the bed on my back with needles in me (iv,pitocin etc), like i was last time, will help to minimise that.

As for pain medication -im confident this wont be an issue (sure i might beg for it for a short while) only because i did it last time without an epidural, with pitocin, on my back, dilating from 5-10 in 20mins. If transition however is prolonged, ok then. But its not a life an death situation.


If labor is prolonged due to mal positioning, t hen at least we have time to get to the hospital if necessary. I mean, thats just bad luck. i would have given it my best shot.

How can i prevent meconium/and/or know if its serious or not? (yes, i will have my midwife, but i'd like to know for myself)

Anything else i missed?

Thanks so much for your repsonses ( i recently read the cord prolapse thread, it was very informative and helpful)
Maya

[bullfrog]

I think those are all really great questions. I think it's fine to ask them here - but if I were you I would definately discuss all of these issues with my Midwife. There is no way that anyone here could answer you completely without taking a full history and well, that just wouldn't make sense. No birth is the same as another. There may be aspects of your first birth that will mimic your second birth - but there is no way to be certain.

Good luck, and many blessings on your upcoming birth!

[Charmie981]

Originally Posted by bullfrog

I think those are all really great questions. I think it's fine to ask them here - but if I were you I would definately discuss all of these issues with my Midwife.

Only your midwife can answer why she would or would not transfer in certain situations.

In many of my transports, it's a "whole picture" issue. I transferred for fetal distress (deep late decels) once, but only after we had changed positions (this remedied the distress, meaning it was likely a cord issue), and allowed mom to labor more. In the end, baby still wasn't tolerating labor well, mom was hurting pretty badly, and labor wasn't progressing. The whole picture added up to transport.

Another whole picture example would be meconium with non-reassuring FHT and a slow labor pattern.

There are a lot of reasons that a midwife might suggest transport. It might help to think that "as long as this labor and birth are a variation of normal and healthy, we'll stay home" but if things go outside of normal and healthy, staying home will probably not be the best idea...

Definitely talk to your provider about these questions, though! I have a list of reasons that we might transport before, during and after labor that I go over with every one of my clients prenatally. I don't want to say to someone in labor "okay, this is outside of my comfort zone" and totally shock them that I'm suggesting transport!!

[Lousli]

You said you are due soon, so I'll assume it isn't an issue in your case, but preterm labor or PPROM could be a cause for transfer. A friend of mine was planning a homebirth but ended up with PPROM at 34 weeks and had a hospital birth with her son.

[RachelSerena]

Originally Posted by contactmaya

Rachelserena-what happened with meconium in your case?

My labor started at 38w7d, and as soon as the water broke we saw the meconium. With about the 10th contraction, a whole pile of it, thick like tar, came out.

My midwife didn't feel comfortable delivering at home in case of inhalation. Also, the FHT were occasionally too low and she wasn't sure that something wasn't wrong.

Baby was completely healthy and didn't need deep suction. I have no idea why she passed the mec in utero - in my case I could have stayed home and it would have been fine. I am not sure that if it happened again, that I wouldn't do the same thing though (transfer, I mean).