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Wwyd? - Page 6

Poll Results: WWYD?

 
  • 47% (121)
    Show up at the hospital late in labor/pushing
  • 16% (41)
    find an underground midwife
  • 1% (3)
    have a UC
  • 15% (40)
    have a c/s
  • 0% (2)
    look into adoption/surro
  • 2% (6)
    not have any more children
  • 1% (3)
    drink heavily until the problem solved itself
  • 14% (38)
    other (please explain!)
254 Total Votes  
post #101 of 137
Thread Starter 
I plan on getting an IUD soon. That sounds like a good idea.
post #102 of 137
Quote:
Originally Posted by frontierpsych View Post
I plan on getting an IUD soon. That sounds like a good idea.
it will be good to be worry free for awhile. actually.. can you let me know how it goes.. i want to get one too. i have a bizarre inability to remember to take pill. lol
post #103 of 137
This is a really tough decision. If you choose hospital birth, the only recommendation I have is to take time to grieve the birth you wanted.

I had a hospital birth, and showed up pushing. The birth wasn't ideal, and it wasn't what I wanted (meaning in a birth pool by candlelight with my jasmine incense, my birth alter and my birth music in the background) but it was still a great birth. I still felt awesome, strong and powerful. I kept my baby with me and left ASAP.
post #104 of 137
Quote:
Originally Posted by acp View Post
Just wanted to correct this. I live in Illinois, and am planning a home birth with a certified, legal midwife. Midwifery is NOT illegal in Illinois. The only issue is that direct-entry midwives are illegal here. I wish they weren't, and have contributed to efforts to try to get a bill passed that would allow for their certification and recognition in the state. But there are many CNMs in the state. The majority, it's true, practice in hospitals (I had a GREAT CNM-attended birth in a hospital with our first child), but there are a number who do home births. And in some cases, direct-entry midwives are teaming up with CNMs to make it "legal."
Given that I do live in a state that has a distinction between licensed and unlicensed midwives, and I know of many great CPMs who are "illegal" here, I understand what the previous posters were trying to say about underground midwives not necessarily being shady or "bad."
That said, I think in this case there are very good reasons for the OP not having a home birth, and I think trying to find a midwife who would be willing to take her on would compound the risk that she'd get someone unqualified to deal with the situation, since many more responsible midwives might suggest she birth in a hospital, given her history.
Ah, you are correct, my apologies, it's been a while since I've had to look for a midwife (5 years lol) so I'm a bit rusty on the legality issue. I was referring to DEMs. I had forgotten that CNMs are legal, probably because they are so few near me.
post #105 of 137
I would go for birth center.

The problem with a hospital birth is that, given how you are made, you are likely to encounter the shoulder dystocia problem again, in which case the hospital WILL use forceps, give you a huge episio, or go for Caesarean. That is simply how they are trained to handle shoulder dystocia. There is no other way that they go about it.

It sounds like your midwife handled it beautifully at home but give the post partum bleeding, I would go for the clinic with a midwife.
post #106 of 137
Quote:
Originally Posted by Synchro246 View Post
Nobody can promise that.
They come a lot closer than an illegal mid-wife or home birth given this history. If I could up my chances to 90% from 50% for having a healthy baby, or ANY IMPROVEMENT, then I'd say yeah, I'll go for it.
post #107 of 137
Quote:
Originally Posted by RomanGoddess View Post
The problem with a hospital birth is that, given how you are made, you are likely to encounter the shoulder dystocia problem again, in which case the hospital WILL use forceps, give you a huge episio, or go for Caesarean. That is simply how they are trained to handle shoulder dystocia.
Shoulder dystocia happens AFTER the head is born, when the shoulders become stuck in the pelvis. Therefore forceps cannot resolve this problem, because forceps are used to deliver the head not the body. An ill-judged forceps delivery (where a caesarean would have been a better option) can RESULT in shoulder dystocia, but forceps are NEVER part of the solution. No one who works in a hospital is trained to use forceps for shoulder dystocia.

An episiotomy might be cut to enable internal manouevres to free a trapped baby. In the event of a shoulder dystocia, you are making a trade between the life of your baby and the health of your perineum. If you don't free the baby with stuck shoulders it will die. Delivering a baby large enough (relative to you) to get stuck is likely to cause some damage to your perineum one way or the other.

Caesarean for shoulder dystocia is a very rare eventuality, and regarded as something of a novelty still. The standard practices are the same amongst all well-trained providers (you can look at the ALSO course for their recommendations - it is attended by midwives as well as obstetricians). The difference with a hospital is as follows:

After a shoulder dystocia, babies are more likely to need resuscitation (and more intensive resuscitation) than after an uncomplicated birth. In a hospital, there are more people around to help resuscitate the baby, look after you at the same time, and a NICU facility if more intensive resuscitation is needed.

Also, after a shoulder dystocia, you are more likely to have a pph (this has two causes. You are more likely to get perineal trauma/cervical laceration. Perhaps more important, pushing a big baby through the pelvis is harder work on your uterus, with labour likely to be longer than if your pelvis was larger/baby was smaller. Longer labour is another risk factor for pph. It is also a risk factor for shoulder dystocia). In a hospital, there are more trained people to respond to a pph (possibly simultaneously with your baby needing resuscitation). They will be more skilled in cannulating (because they do it all the time) and this is exactly what you need when having a pph.

I'm very supportive of homebirth, but there are situations in which hospital has clear advantages. And when you can foresee a shoulder dystocia, that is one of them. Caesarean section - planned or in-labour - also doesn't have to be the end of the world.
post #108 of 137
I voted for underground midwife if you dont want a hospital birth.
There isnt really anything that can be done in the hosptial about SD that cant be done at home. And if you dont believe that you are high risk for another hemmorage I would homebirth, but only if the midwife had access to drugs for hemmorage and you could transport quickly in an emergency. I would definitely not UC! You need a skilled birth attendant to get that baby out if its dystocic again.
I would say doing a homebirth might be risky, but I dont think its totally insane if its really important for you to have a homebirth.
But you can certainly have a good hospital birth with a doula, but realize they are almost certainly going to induce you before you are due to prevent you from having a big baby... you might have to refuse a lot of interventions and they might be quick to diagnose CPD.
post #109 of 137
Thread Starter 
Quote:
Originally Posted by Yehudit View Post
An episiotomy might be cut to enable internal manouevres to free a trapped baby. In the event of a shoulder dystocia, you are making a trade between the life of your baby and the health of your perineum. If you don't free the baby with stuck shoulders it will die. Delivering a baby large enough (relative to you) to get stuck is likely to cause some damage to your perineum one way or the other.
Actually, I didn't tear with either of my births. I have a strong perineum. Both SD babies were able to be maneuvered without an episiotomy, just the first time it was too late.
post #110 of 137
Quote:
Originally Posted by Sage.Naissance View Post
There isnt really anything that can be done in the hosptial about SD that cant be done at home.
Except in the hospital they have a lot more available for neonatal resuscitation. That right there would be a huge factor for me.
post #111 of 137
Quote:
Originally Posted by frontierpsych View Post
Actually, I didn't tear with either of my births. I have a strong perineum. Both SD babies were able to be maneuvered without an episiotomy, just the first time it was too late.
Well, I said an episiotomy *might* be cut in the event of SD (the mneumonic is HELPERR, the E standing for EVALUATE for episiotomy, not an automatic decision to cut one).

I also said that where you have a shoulder dystocia with a large baby, you are *likely* to get perineal trauma (whether from an episiotomy or a tear).

But nothing is definite, so of course it is possible to deliver a large baby over an intact perineum.

Most caregivers would do an episiotomy in order to do internal maneouvres to resolve a shoulder dystocia, because if the baby's head is pulled hard back against the perineum (the turtle sign) it's difficult to get in to do internal maneouvres without doing an episiotomy. The priority at that point is to free the baby's shoulders as quickly as possible from the point that the dystocia is identified, and the mother's perineum is of less importance at that point.

I don't think tearing is really to do with having a "weak" perineum, but more to do with the position of the baby (if the baby has a hand up, you'll be lucky to get away without a tear) and the speed/mechanics of the birth itself.
post #112 of 137
I feel for you Frontierpsych. I remember when you lost your daughter and I was thrilled when your son was born recently.

I've been in a similar position, I lost my 2nd baby to s.d. and I chose to have a scheduled c/s for #3 & 4. I had an enormous pph also with my s.d. and came close to death, also I became rh sensitized. I saw a therapist who is linked into the natural/homebirth community where I live and together we came to the conclusion that c/s was safest for me. I then put my energy into healing well and focusing on all the things I could do to maximize bonding. Both of my c/s involved very minimal blood loss ( and that's a big deal for me b/c it could raise my rh titer) and my second c/s was everything I dreamed of with hb & never got. I had my baby on my chest as soon as he was out and he stayed that way for the next 3 days. Every nurse left us in peace and was nothing but kind and helpful.

I think it can be a tough choice, but you will know what to do. Its not about what people here tell you to do, you will clearly know what makes you feel most comfortable. Good luck!
post #113 of 137
Oh my goodness. I am so sorry for the loss of your daughter, first of all.
I would not personally choose an unassisted birth or a home birth had I your history. I don't know that I would necessarily choose a c-section absent some other issue, but I would want at the very least to have resus available as well as the ability to treat a PPH. I think Yehudit has some very wise advice.
post #114 of 137
I definitely would give yourself plenty of time to work through your feelings about things, and even figure out if you want another.

I think based on the blog that your midwife posted, you may very well have a narrow pelvis (I rarely hear midwives say something like that). Though she didn't mention much about pph in her blog. Personally, I would try to find another midwife to attend the birth if you choose to birth, whether it is in a hospital or at home.

to you, whatever you decide.
post #115 of 137
Thread Starter 
Quote:
Originally Posted by phatchristy View Post
I definitely would give yourself plenty of time to work through your feelings about things, and even figure out if you want another.

I think based on the blog that your midwife posted, you may very well have a narrow pelvis (I rarely hear midwives say something like that). Though she didn't mention much about pph in her blog. Personally, I would try to find another midwife to attend the birth if you choose to birth, whether it is in a hospital or at home.

to you, whatever you decide.
she decided not to include anything about the events after the birth, that's all.
post #116 of 137
I haven't read all the other posts, but I agree with zinemama. While most women don't need hospitals and doctors, there are cases and situations when they really are the best and safest option. It sounds like your situation is one where a homebirth is unsafe and you're best off in a hospital.
post #117 of 137
Quote:
Originally Posted by frontierpsych View Post
she decided not to include anything about the events after the birth, that's all.
Did you wind up transferring?
post #118 of 137
Thread Starter 
Quote:
Originally Posted by phatchristy View Post
Did you wind up transferring?
no, but we almost had to. They got it under control.
post #119 of 137
Quote:
Originally Posted by Yehudit View Post
Shoulder dystocia happens AFTER the head is born, when the shoulders become stuck in the pelvis. Therefore forceps cannot resolve this problem, because forceps are used to deliver the head not the body. An ill-judged forceps delivery (where a caesarean would have been a better option) can RESULT in shoulder dystocia, but forceps are NEVER part of the solution. No one who works in a hospital is trained to use forceps for shoulder dystocia.

An episiotomy might be cut to enable internal manouevres to free a trapped baby. In the event of a shoulder dystocia, you are making a trade between the life of your baby and the health of your perineum. If you don't free the baby with stuck shoulders it will die. Delivering a baby large enough (relative to you) to get stuck is likely to cause some damage to your perineum one way or the other.

...

After a shoulder dystocia, babies are more likely to need resuscitation (and more intensive resuscitation) than after an uncomplicated birth. In a hospital, there are more people around to help resuscitate the baby, look after you at the same time, and a NICU facility if more intensive resuscitation is needed.

Also, after a shoulder dystocia, you are more likely to have a pph (this has two causes. You are more likely to get perineal trauma/cervical laceration. Perhaps more important, pushing a big baby through the pelvis is harder work on your uterus, with labour likely to be longer than if your pelvis was larger/baby was smaller. Longer labour is another risk factor for pph. It is also a risk factor for shoulder dystocia). In a hospital, there are more trained people to respond to a pph (possibly simultaneously with your baby needing resuscitation). They will be more skilled in cannulating (because they do it all the time) and this is exactly what you need when having a pph.
If you read the OP's blog entry regarding her last home birth, it seems like the midwife did exactly the right thing: Gaskin all-fours maneouvre followed by midwife inserting hands to pull baby out by his armpits.

Why is an episiotomy in a hospital preferable to this? I don't get it. Especially when you consider that many hospitals would not even let you TRY going on all fours first to get the baby out that way. Yet in 85% of shoulder distocia cases, simply going on all fours solves the problem within minutes.

Midwives bring oxygen with them to home births and are very capable giving oxygen to babies as needed.

The only possible argument I can see for hospital birth is the possibility of post partum hemorrhage, personally. And I would still choose a birth center over hospital.
post #120 of 137
Well, if I were you and wanted more children? I'd just go for the section. because you had two shoulder distocias and two hemmorhages. HELLO! Either of those, alone, would make me think.
I lost a 15 year old last month. I had a 10 pounder last year with mild shoulder distocia, everything was fine after a gaskin maneuver.
Losing a child. A newborn you barely knew? horrible. An older child? unimaginable. It happens anyway. Surgery to avoid a loss that seems very possible if not probable? Certainly acceptable. The danger to your babies from a c-sec is not a trade-off to the dangers of a vaginal birth with SD and PPH. Different risks, not related to one another. Your risk of repeating each of these life-threatening complications after two separate instances, is separate to any risk towards your currently healthy baby. Keep that baby safe, even if it means compromising your ideals.
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