So far I've decided that prior to baby being fully born I would transfer if there was a cord prolapse or placenta previa. I did one us this pregnancy (only one last time too) at 22 week and the placenta was at the back away from the cervix. I think it's highly unlikely that it would migrate down, plus there'd be symptoms, so I'm not too worried about that happening.
I'm on the fence about breech, I've read too many stories where baby perishes because doesn't make it out on time.
I can't think of any other reason I might go to the hospital prior to complete birth.
After the baby is born I would go of baby needed medical attention or if I was hemhorraging.
Am I missing something? I want to be prepared because last time I wasn't and it was horrible.
Here is my list-
1) Cord prolapse- sometimes this can be fixed, but I wouldn't chance it.
2) Mom hemorrhaging- more than 5-6 cups of blood.
3) Meconium- only if there was lots of it, very thick, when the water broke. Otherwise, I'd wait with my infant aspirator and cell phone on hand to judge the baby's APGAR when baby is delivered.
4) Blood pressure- with the lower number higher than 100 (this just happened to me).
5) Labor fully starts before 37 weeks- Even if the labor goes fine, the baby might need its breathing watched for 24 hours. I debated on how early I was okay with a lot before deciding this.
If you know your placenta is in a good spot, no need to worry about that anymore. I personally would deliver twins and breech at home. That is my own comfort level. Also seems like most cases of shoulder dystocia can be resolved using various positions. I wasn't concerned about that.
Keep reading, researching and learning. The more you dig, the more bits of knowledge surface that will help you with your own list and comfort levels. Not everyone will have the same list in this regard. I agree that it is important to feel relaxed and confidant going into labor. That alone could make all the difference between a great birth and a problematic one.
I didn't realize meconium was a transfer thing, I've read so many homebirth stories where there was meconium but it was no big deal... Something for me to research now, thanks :)
Kailey 8.1.06 Midwife - Hospital
Nola 3.20.09 Midwife - Homebirth
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@happy9 - do you distinguish between thick mec when the waters break vs thick mec that comes some time after the water breaks? Which situation would you transfer in, and what's your reasoning. I hope these questions are okay, not too invasive!
I'm still seeing my midwives and asked today about mecomium and they said protocol is to transfer if there's any mec at all. From what I've read there's mec 30% of the time and MAS (mec aspiration) is extremely rare. I think it's way more likely if the mec is thick. It makes no sense to me why all cases of mec stained liquor would require a transfer - and continuous EFM, which I absolutely would not endure again.
Here also the "rule" is to section all breeches, which also makes no sense. From what I've read the only time breech necessitates c-section is if babe is transverse lie - and as if that would happen. It's riskier with footling breech due to the chin issue but that's a small risk too, and with bum first the risks seem to be more hypothetical than real.
Anyway, all that goes to say that the "rules" are often not evidence based and appear instead to be based on medico legal or social reasons. I would not agree to a section for a bum first breech - ridiculous!!
Here's the great article I found on mec stained liquor:
I think your conclusions on meconium
are pretty solid (thick meconium=cause for serious concern), but there's one thing you wrote in your comment on breech that I have to disagree with.
You wrote that it is it, "riskier with footling breech due to the chin issue but that's a small risk too.".
Actually, footling breeches are super risky. The odds of cord prolapse for a term footling breech are around %15! (Compare with .5% risk with frank breech-- 30 times higher!) That's waaaaay beyond my personal definition of low risk. I know that some people have done them at home, but frankly
It scares the bejesus out of me... you're really not far from Russian roulette type odds with a footling.
(On a lighter note: I once talked to a doc who had a patient who liked the sound of the word meconium so much that she named her daughter that! To each her own!)
A transverse position! I forgot to put that on my list. I read one story about a woman who pushed for 5 hours before going to the hospital and finding out she needed a c-section for transverse position.
If I had what I thought was a lot of meconium at any point, I would go to the hospital. It'd need to be thick enough that if I touched it, it'd be smeared all over my hand. A little bit doesn't seem to be a problem.
I think breech births can have serious problems when the mother has an epidural, because you need to be able to push the head out in something like 5-7 minutes. I've never had an epidural and pushed my first two out without problems, so this was never a worry for me personally. I can see how it would make modern doctors nervous, but I hate that they just want to follow standard practices and avoid being sued over what is best for mom and baby.
I just wanted to add that my second baby was transverse for much of the pregnancy, but she sometimes shifted into another position, so I knew she had plenty of room and agility to move and I didn't spend much time worrying about it. Midway through labor it occurred to me to think about what position she was in, and sure enough, she was transverse. I told her out loud, "hey, now would be a good time to go head down," and after about 30 seconds she moved, and was born head-first a couple of hours later. :) So for me, baby's position wouldn't be a concern unless she had trouble moving in the months leading up to birth.
I'd pretty much transfer for cord prolapse, or instincts shouting "danger!" before birth.
After birth, for major maternal blood loss or shockiness that doesn't go away after home treatment, or something clearly wrong with the baby.