"emergency plan"... Anyone have one? - Mothering Forums

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#1 of 9 Old 07-17-2007, 03:51 PM - Thread Starter
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So, I have a great MW for my planned HB, everything is going perfect so far. I am not too worried about things going wrong... BUT I have read of women having an "emergency plan" so that they don't end up in the ER with whatever Dr. is there....

I was just wondering if anyone here is doing that? And if so, how do you coordinate with an OB to be an emergency back up? Should I just start with my regular OB/GYN, and see if she would do it? I just can't imagine too many Drs would be happy with this....
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#2 of 9 Old 07-17-2007, 04:26 PM
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There are a number of issues to consider here.

If you choose an OB who is opposed to your birth plans (and they might not tell you that up front) they may find a way to subvert your plans. Sometimes this can be done by insisting on tests, then overreacting to them. I can elaborate more if you like.

If you have a true emergency, odds are slim you will actually see that OB. You will be cared for by whoever is on call or on site.

On the other hand, some people say that hospitals treat you better if you have an OB you've seen.

I've had one homebirth. During that pregnancy I needed treatment for an infection (severe food poisoning), and was able to get that through a CNM. Where I live now I'd need an OB for the same treatment (if you are pregnant here, nobody but an OB will touch you). I also wanted an ultrasound because I was measuring way over dates, something like 56cms at 30 weeks. Some of the things that can cause that might cause me to prefer a hospital birth, so we checked. Everything was fine, and I went on and had a homebirth, but that OB's office kept calling to see if I'd had my baby then fussing about "going over dates" and it was a Doctor who attends homebirths!

This something I'm struggling with myself right now. The MW I was going to hire before I miscarried recently, likes her moms to have an OB for "shadowcare". She feels they get better treatment in the hospital if they transfer (her transfer rate is very low), but was OK with me choosing not to do it. So now I am going to try to find an OB now while I'm NOT pregnant. Maybe I'll call the local hospital and see if the nurses will tell me who is more supportive of natural birth. I'm trying to find c/s rates of specific doctors online because that's very telling, I think.

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#3 of 9 Old 07-17-2007, 05:12 PM
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I had to write out two transfer plans:

1. An emergency transfer where we went to the nearest hospital's ER
2. A transfer where we went to labor and delivery of the hospital of my choice (I picked the hospital my MWs backup OB works at)

In a transfer situation, it's more likely to be #2 so I wouldn't spend a lot of energy on worrying about ending up in the ER.
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#4 of 9 Old 07-17-2007, 05:51 PM
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I am seeing an OB (that I like) and am just not telling her that we are planning a homebirth. (I live in a state where the only legal midwives are CNMs and they dont do homebirths, though a law recently passed that should change this). This is not the answer for everyone, but felt right to me. I figured if for some reason I would need to transfer, the last stress I need to have is worrying about getting crap from the hospital for not having "prenatal care". Also, my insurance this way covers all of the routine tests that I chose to do.

Also, in a "true emergency" situation, I realize I have no control over who I would see, but in that case, you never would.

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#5 of 9 Old 07-18-2007, 03:06 AM
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I discussed this with my MW during my last pregnancy. She has a back-up OB (whom I've now met and am on their records), but he's a 20-30 minute drive, minimum. Since there is NO way I'm transferring for anything but a truly emergent situation, it's highly unlikely I'd go to him.

There is a hospital just down the road from us - no more than 10 minutes by car. If there were a significant problem we'd head there. The fire station is literally 2 minutes from my house and the EMS station is maybe 4-5, so if we needed to call for assistance it would be here very soon, and the hospital would be on alert. Even if we transported ourselves, we could call the hospital and have them prepped, and be there before they were ready.

So, given all of that, we have no specific plans for a preferred OB - though should anything happen we'd certainly be praying for the right one to be there!

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#6 of 9 Old 07-18-2007, 06:11 PM - Thread Starter
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So confusing....

Thank you all for answering.

We also live VERY close to the hospital with a brand new ER... I guess like a pp said, If its a true ememrgency, then you would just have to go there and keep your fingers crossed that the Dr on duty will work with your MW. I guess I prob wont try to get a back-up OB.
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#7 of 9 Old 07-19-2007, 02:42 PM
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We are lucky in that we live in a state where CNMs have comparatively wide privileges -- they can't admit to the hospital alone, but they can attend births on their own outside of the hospital, prescribe, carry drugs and emergency gear, and order tests. So, there really isn't any need for 'shadow care' and our emergency plans are pretty basic.

If it's an emergency transfer, we'd go to whichever hospital in town we chose (they're like 7 blocks away, so 'closer' really isn't an issue). Our midwife is an ex-hospital CNM and has cultivated good relationships with the OB staff of both hospitals and is pretty well-respected as the owner of the local birth center, which seems to smooth the way pretty well. We did write a 'birth plan' for both a hospital vaginal birth and a c-section and pre-registered at the hospital, which was required by our midwife. We also made sure everyone involved (hospital, labor support, midwives) had copies of the birth plans and powers of attorney (in my state no one can consent to health care on behalf of a pregnant woman without a power of attorney).

If there had been complications that weren't emergencies or that arose not during labor (like a breech baby) we would have consulted the birth center's back up OB and decided whether to transfer care to him or another OB who was closer, since he practices in a exurb of our town.

We didn't have to try any of this out, thank God! But I do feel like it was enough to smooth the way if there was an emergency.

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#8 of 9 Old 07-19-2007, 04:28 PM
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Nah. I had a backup practice that I was friendly with who was willing to work with me in the event of a non-emergent transfer. And my midwife offered to make contact with L&D at our nearest hospital so that she'd be known in case of an emergent transfer. But I think if there's a true emergency, plans matter less than dealing with the emergency.

A good midwife is the most important tool in avoiding an emergency situation as much as such a thing is possible.
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#9 of 9 Old 07-19-2007, 05:36 PM
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Yes, absolutely. I think having a back-up plan is vital. You won't need it, most likely, but it's there just in case. And unlike other "just in case" things, this one can't hurt to have

I agree with pps, if it's a truly emergent situation, you'll go to the nearest hospital and OB that's on call right then. So you can't do much about that other than be aware of what hospital/OB group that is for you, and perhaps be aware of any egregious policies that you'd have to deal with in that situation.

If you need to transfer for something less than a true emergency, then you have more flexibility. For me, my MW works (when necessary) with a HB-friendly team of OBs in a hospital 30 minutes away (as opposed to the one 10 minutes away, where my dd was delivered). I can't imagine going to the hospital for much less than a true, we-need-to-get-this-baby-out-stat kind of emergency case, but you never know. And I'm a planner, so having decided these things is reassuring to me. One less thing to think about in the heat of the moment. And once you've thought about it and you, your dh and your MW are all on the same page, then you can forget all about it and go back to planning your peaceful, gentle homebirth.

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