TRUE emergencies vrs TERMED emergencies? - Mothering Forums

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#1 of 8 Old 08-17-2008, 01:06 PM - Thread Starter
 
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Hello everyone! I have a quick question...just wanting to draw on your professional opinions from both your "book knowledge" expertise, as well as all your experiential knowledge thus far in your practice...

What all "true emergencies" can NOT be handled at home?
i.e...cord prolapse,
placental abruption,
aminiotic embolism...etc.

what "termed" emergencies most likely CAN be handled at home?
i.e...nuchal cord,
shoulder dystocia,
breech births...etc.

I say "termed" emergencies in that most of todays society believe these are emergency situations that can only be handled in the hospital or via a cesarean, but with more research it seems I am learning that "blanket all" statement or belief is simply not true. (such as meconium?)


What has been your experience in your practice? I hope I haven't worded this too confusing? *blush*
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#2 of 8 Old 08-17-2008, 07:34 PM
 
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I am still just studying and dont have experience as a midwife, but some as a doula and mom. so I cant really offer a reply other than I am really glad you asked this, and the way you asked it.
I am excited to see what other have to say as I feel soooo many "complications" are treated as dire emergency when really they can be handled and resolved without so much freaking out, for lack of a better term. the nucal cord is a good simple example, I dont know how many people have told me horror stories about their birth, following it with how extreamly greatful they were for the medical staff because they are convinced baby would have strangled if DR. hadn't unlooped the cord!

I think that early onset of pre-e and suspected marginal low fluids at the end of pregnancy are the same way. Maybe we need another thread for "complications during pregnancy" as well as "emergencies during birth" as you asked here.

K, sorry for rambling, just thought this is a good one and hope we get some input from these great ladies!

Lisa~Was Aspiring Midwife~Now-AAMI Midwifery Student #2020~Mama to Zackery 3/29/96, Drake 9/22/01, and Selina 10/26/03...and here was the link to my new blog
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#3 of 8 Old 08-17-2008, 07:52 PM
 
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I guess it depends on the severity of the complication, other confounding factors, and a view of an individual woman and baby's unique circumstances. For example. a small hemorrhage that resolves with simple interventions, vs a torrential hemorrhage that results in the need for a blood transfusion or surgical intervention. How blood loss affects an individual woman would depend on factors unique to her (health status, iron levels, for example). Another example would be a 'simple' shoulder dystocia that resolves with a couple of interventions vs. one which results in a baby who is profoundly unwell and requires intubation and ventilation support. How well a baby would tolerate sticky shoulders or a dystocia would be dependent on factors such as whether there was a nuchal cord, whether the baby was doing well in the labour, if the baby was fighting infection or other complications. It isn't as simple as a list, really.

I am very comfortable at home, and part of the informed choice a woman has to make when planning a home birth is being at peace with the fact that many things will be just fine to handle at home, but there will be situations that will be better handled at the hospital and/or by specialists in *rare* circumstances. This is contrasted with the risks of some women being acutely uncomfortable in a hospital setting, the increased intervention rate, the increased infection rate, etc. Only the woman can decide for herself which risks and benefits are the most important to her when choosing place of birth.

Part of the relationship a woman might form with her care provider would form the basis, in an ideal world, of a relationship of trust of the midwives' skills and intuition and experience, and the midwife trusting and believing in the woman and normal birth, to make the recommendation to go to the hospital or to continue at home when things started to move away from ideal. Those decisions can't always been quantified or qualified when care providers don't blindly follow protocols and decision-trees, but individualize care to the woman and her unique circumstances.

Does that all make sense?
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#4 of 8 Old 08-17-2008, 08:01 PM
 
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To me, just because something can be "handled" at home doesn't mean it's not a true emergency. Midwives are trained to deal with emergencies such as hemorrhage, shock, shoulder dystocia, neonatal resuscitation... that doesn't make them any less life threatening.
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#5 of 8 Old 08-18-2008, 10:27 AM
 
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I'd agree.
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#6 of 8 Old 08-18-2008, 10:37 AM
 
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CarolynnMarilynn--I like and agree with your comments very much, thanks for posting. You said what I couldn't figure out how to say about this (at least, not without using a lot more words!).

I kind of agree and kind of don't agree with nashvillemw on the 'emergency' point. All of these potentially dangerous situations exist on a continuum....so, a shoulder dystocia that resolves with some help but baby is fine, is not an emergency or 'life-threatening' just because it was an SD. I've seen partial placental abruptions that resulted in normal birth for mom and baby...*could have been* an emergency is not the same as an emergency.

But in general, I work to normalize birthing perceptions and language, and to defuse the fear-charge placed on variations of the norm--in great part by our use of words. Sure, there are situations I consider to be more urgent....but still not emergent. There are situations that require more of my 'serious midwifery skills' than most births do, but even so I don't call all of those emergencies...and in my mind, even 'urgent' can mean something along a continuum.
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#7 of 8 Old 08-18-2008, 12:08 PM
 
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I have a great deal of indecision on replying, not just a couple of words are going to cover it. the first book I read on OB after my 2 hospital births was Obstetric Emergencies-- it helped to bracket my fears, I guess for me because not knowing was limitless and everything was possible.
as for emergencies we try to avoid them, and if something is remedied easily or simply then we tend to down play it
you would need to read my protocol list and probably a stastics list to glean from it what you want to know--- I would recommend that you find some of the text books on midwifery -- like the Midwifery Handbook by Constance Sinclair and look it over it might help answer some of your questions also the British Medical Journal article that was CPMs stats

good luck
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#8 of 8 Old 08-18-2008, 11:33 PM
 
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[QUOTE=MsBlack;11971903]CarolynnMarilynn--I like and agree with your comments very much, thanks for posting. You said what I couldn't figure out how to say about this (at least, not without using a lot more words!).

Thank you for the nice compliment.
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