The homebirth to hospital transfer: some perspective - Mothering Forums

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#1 of 12 Old 12-07-2011, 08:00 AM - Thread Starter
 
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Hi mamas. I've been coping with the trauma of a planned homebirth gone c-section with my first babe, born six months ago.

 

It seems like a lot of other moms are working through some of the bad vibes that can arise after this scenario. I found a wonderfully researched article that might help.

 

http://dynamicdoula.blogspot.com/2011/04/my-midwife-failed-me-how-homebirth.html

 

I don't care for the title- I personally don't feel like my midwives failed me at all. But the info is still very useful. 

 

Cheers,

 

Partaria


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#2 of 12 Old 02-16-2012, 09:25 AM
 
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How do they come up with those stats?  NO csections should be occurring at home.  They should be occurring in the OR.  

 

Similarly, yes, I would hope fewer babies die at home.  I would hope when it is noticed that they are in trouble, they are transported to a hospital.  If they die at home its because people weren't trained well enough to know to call 911.

 

Right?  Very suspicious of these stats.

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#3 of 12 Old 02-16-2012, 09:33 AM
 
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The stats reflect the planned birth. Obviously all the csections took place in an OR but they BEGAN as a planned homebirth. Likewise the deaths are the babies that died after an attempted homebirth, regardless of whether they died at home or in a NICU.
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#4 of 12 Old 02-16-2012, 09:43 AM
 
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My midwives didn't fail me either.  The OB on call was wonderful.  I did the very best that I could.  It was only after we got to the hospital that the decels started and at that point there was meconium, so down to the minute, I went as long as I could have, safely.  I didn't transfer for pain or exhaustion.  We transferred because my midwife had good instincts about 21 hours being long enough and we needed help at that point.

 

Its no one's fault, its just that birth cannot actually be trusted, any more than a run-of-the-mill wife beater or serial cheater can be trusted.  And as far as all the "variations of normal" like breech, or multiples, or big babies, or wrapped cords or what have you - *death* is also a variation of normal.  The survival of the species is not dependent on little old me and one little baby.  Nature, actually doesn't give a crap about me.  You and I are EXPENDABLE.  We can be "WASTAGE" as far as nature is concerned.  Its up to us to fight with all instruments of advanced medical technology afforded us AGAINST nature sometimes.  And that's what I ended up doing 15 months ago when I had a csection.  I mourned every day, constantly, for my perfect home water birth that everyone was seeming to have.  I was completely blindsided.  I wish I had known that almost HALF ftm's transfer.  I wish I had known those were my odds.  I think I would have been a lot better prepared emotionally.

 

I'm sorry it didn't go your way.  You're not alone.  It gets better, but the world looks a whole lot different this side of the grief.

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#5 of 12 Old 02-16-2012, 09:53 AM
 
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Also this

 

"One meta-analysis found that the neonatal mortality rate tripled in planned homebirths versus hospital births, and attributed the better outcomes for babies to the decrease in interventions [2]."

 

 

 

is not a better outcome... 

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#6 of 12 Old 02-17-2012, 11:06 AM - Thread Starter
 
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I think the author of the post simply mixed up her antecedents there. If you read the whole paragraph:

 

There is no way to sugar-coat that. Babies born at home die less often -- because of the lack of unnecessary interventions. One meta-analysis found that the neonatal mortality rate tripled in planned homebirths versus hospital births, and attributed the better outcomes for babies to the decrease in interventions [2]

 

I think she's trying to say that babies have higher mortality rates in the hospital, not out of it, and the "better outcome" is the lower mortality rate.

 

I see what you mean about the stats. You can certainly look at her references to investigate more about the studies she's citing.

 

I think the most interesting part of this article was introducing the idea that women in culurtures where homebirth is sort of this embattled semi-edgy thing to do tend to report being more depressed and upset, emotionally, regarding transfer. This was certainly the case for me. When all was said and done, I had so much anger toward the whole "trust birth" and "anyone can give birth at home vaginally if she does just x, y, or z" stuff after my birth.  As I like to say, I did x, y, z, and the whole cyrillic alphabet to boot, and my baby STILL had to be born via c. The only conclusion I was left with, after all I'd read was that I was a failure and my body was freakish because I couldn't birth "normally." My body was supposed to know how, right? But it didn't. 

 

I think when we try to empower women to give birth their own way, we have to be careful not to frame things in such a way that we behave as though birth isn't a wild, power all of its own. We should take back birth, but remember to still be humble before it. It is a force of nature, and sometimes our will and our planning is simply not enough. 

 

Just my two cents. I agree with a lot of what your saying, Lady Jade.

 

 

 

 

 

 


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#7 of 12 Old 02-17-2012, 12:40 PM
 
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The author here is deeply, deeply confused.  I believe the Wax study she cites showed triple the risk of neo-natal death for planned homebirth versus hospital birth, and was part of the basis of the 2011 ACOG opinion letter against homebirth. 

 

In any event, the best and most recent study on homebirth was the British Birthplace Study which, all things together, shows that homebirth is not advisable for first time mothers.


I support homebirth that meets the qualifications set forth in the AAP's 2013 policy on homebirth.

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#8 of 12 Old 02-18-2012, 03:04 AM
 
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It did NOT find that it wasn't advisable for first timers not to birth at home!  It found that for first time mothers there was a 0.4% increase in risk of complication for the neonate.  Those complications covered everything from needing some suctioning at birth (and then being totally fine) to neonatal death, and the authors stated that first timers should be made aware of that and what it really meant and supported in their decision-making.  The study actually drew no conclusions about neonatal deaths because the authors found the total numbers of deaths was so small it was impossible to extrapolate specifics.

 

I really agree with Partaria.  The fact that you have to fight so so hard to GET a crack at homebirth makes it very difficult for transfer to deal with.  Because you feel no one believes you "can do it" you're trying to prove something all through pregnancy which, in reality, YOU cannot "prove" because it's really down to the baby, the labour, and plain old luck as to whether or not you will be giving birth at home or not.  In addition when you are advised or urged to transfer you wonder "is it REALLY medically necessary?  Or is this just my care-provider showing their true home-birth-fearing colours?" which makes the decision much harder/more open to regrets.  I know several women who've transferred for a slow or obstructed labour who gave birth in the ambulance.  Whether it was the walk down the stairs, the bumpy road under the ambulance, the change of mood in "doing something" or the change in atmosphere of those who might have been becoming afraid feeling relief that they are going into hospital or NONE of the above which got things moving the mum will never know, and if she had to make such a big big deal about wanting a homebirth to get a shot at having one everyone around her, and inevitably she herself, might end up viewing the transfer as some sort of failure.  They think "i was fine, i could have done this at home" and homebirth is such a rare thing that it's seen as a pinnacle of something rather than just one of many options.

 

What would be great is a cultural view of birth which acknowledged that homebirth can be a very safe and very good idea, and that hospitals can be a very safe and extremely good alternative in those instances where they are desired or necessary.  That way you could have a shot at whatever birth you wanted and if it turned out that the birth you NEEDED was different it wouldn't mean too much.  If you have a really good OB and MW who both support many women in homebirths and practice evidence-based care, when they say you need a c-section you can feel really confident that you do.  If having a homebirth was no big deal transferring would be less of a deal for many too.

 

I've had both of mine at home.  DD1 DID need suctioning and oxygen (and then was totally fine) at birth (apgars 9, 7, 10).  DD2 had a true knot in her cord and could have died wherever i gave birth but fortunately was good at driving a cautious labour and came out in better condition than her sister had (apgars 10, 10 10).  In both cases i had excellent midwives who acted swiftly and expediently and my stories are happy.  But it wasn't anything to do with me or my actions, it was everything to do with plain old luck.

 

It's so hard, because unless some of us insist on trying for a homebirth the culture of birth WON'T change, and it will remain hard to find care and support for them.  But for those who DO try for them in the current culture the polarity of opinions both of care-providers and in general, leaves those for whom it doesn't go as planned feeling like they failed.

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#9 of 12 Old 02-18-2012, 05:17 AM
 
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"What would be great is a cultural view of birth which acknowledged that homebirth can be a very safe and very good idea"

 

Of course you can have as many "cultural" ideas as you want.  However, its a little difficult when they run afoul of the science.  I believe there are no good studies that show that here in the US that what you are claiming is true.

 

We have one study from B.C. (Canada) that shows good results in B.C. and we have the Birthplace study in the U.K. (using highly trained midwives, extremely liberal transfer protocols, eliminating all women who have any hint of the tiniest bit of risk and the study itself performed in an socialized medicine environment that had already decided prior to the outcome of the study to push homebirth as cost-saving).  As far as I'm aware -- that's it for positive results.

 


I support homebirth that meets the qualifications set forth in the AAP's 2013 policy on homebirth.

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#10 of 12 Old 02-18-2012, 02:20 PM
 
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Buzzbuzz i'm in the UK and have had 2 homebirths here.  Believe me the cultural belief is NOT that it's a good idea because it's cost-saving, not amongst the public and certainly not amongst the majority of obstetric staff and when that study came out the media here ran the headlines with "babies of first time mums die at home", every SINGLE newspaper and news group ran with the (tiny) increased risk and ignored the overall findings that birth in the UK, regardless of location, is very safe.  The government would like it if it were changing the culture, but it isn't.  Homebirth is much more common here, but it is still seen as risky and "brave" by the vast vast majority.

 

But i do totally agree with you, in the US the word "midwife" can mean a lot of different things and really homebirth isn't as safe over there purely because of that.  My own midwives were highly trained, highly experienced and highly skilled.  You can find that in the US, but you're not guaranteed it when you find someone calling themself a midwife.  I wish that could change for you guys.

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#11 of 12 Old 02-19-2012, 05:34 AM
 
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Out of curiosity, since you are a UK homebirther -- the impression I got of the Birthplace study was that the criteria for being included in the study as a homebirth mother were actually *stricter* than the criteria actually used to homebirth in the UK.  With the result being that the study results were not actually representative of what is going down "on the ground" currently in the UK? 

 

Also, isn't it also accurate to describe the increase you are talking about as a "doubling" of risk?  While double of a tiny number is still a tiny number, it isn't so small to those who fall within the percentage of the increase, right?


I support homebirth that meets the qualifications set forth in the AAP's 2013 policy on homebirth.

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#12 of 12 Old 02-20-2012, 09:54 AM
 
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Quote:
Originally Posted by Buzzbuzz View Post

Out of curiosity, since you are a UK homebirther -- the impression I got of the Birthplace study was that the criteria for being included in the study as a homebirth mother were actually *stricter* than the criteria actually used to homebirth in the UK.  With the result being that the study results were not actually representative of what is going down "on the ground" currently in the UK? 

 

Also, isn't it also accurate to describe the increase you are talking about as a "doubling" of risk?  While double of a tiny number is still a tiny number, it isn't so small to those who fall within the percentage of the increase, right?


Homebirth in the UK is the mother's right.  So while they can say "we strongly advise you that a homebirth would be dangerous" they cannot refuse to attend you (if they really feel you're high risk they can however show up and immediately call an ambulance).  Thus the study was made "stricter" because although it is not officially "allowed" there ARE women who are VBAC, VBA2C, carrying twins, high-BMI, "old" etc. having homebirths.  Equally there are absolutely women who are young, healthy and having a normal pregnancy being risked out for ridiculous reasons - it's just that they cannot DROP care, so if you know you can refuse to go in then you can still attempt a homebirth.  Does that make sense?  Truly there IS no "criteria" for a homebirth here, but depending on your care you might have a serious uphill fight to have one even if there's no actual medical reason not to - when i was having #1 i had NHS midwives and while they were very good they were stuck with all the hospital protocols and it made my care patchy and unsatisfactory.  For example i was told that i had an "untried pelvis" (something which was relevant in the times of rickets and polio in the UK but which is medically irrelevant for 99.99% of modern UK women) when i booked and should not homebirth because of it.  And then told by a registrar that at 10 days past 40 weeks homebirth was far too dangerous an option (stillbirth risk increasing being her reason for saying this) and she then went on to tell me i must instead be induced in the hospital - when they fetched the ward book the next induction spot was when i was 40+15 and she solemnly wrote me in for it!  Needless to say when labour began at 40+11 i didn't rush in.  They did a GTT when i was 41+2 AGAINST my consent in another attempt to find a reason to discourage homebirth.  They basically get twitchy as soon as ANYTHING happens that isn't textbook "normal" - with DD2 i had an independent midwife, of which there are very few remaining (they are the only way to get assured one to one care now) but booked with a hospital too, in case i should need to be transferred, and the midwife there told me i couldn't have a homebirth with my hypothyroidism, despite it being very well controlled - they failed to even diagnose it with DD1 when it was truly dangerous (as it was uncontrolled)!

 

Fear is rife still - i know many women who have successfully homebirthed and many many more who have transferred for long labour (after 5 hours of contractions in one case!), slow progress (2 of the 3 i knew who transferred for that gave birth in the ambulance), "non reassuring foetal heart tones" (in one case baby was distressed, in the other 3 the drop in rate was caused by the head passing the ischial spines (which causes a vasovagal response), all those babies came in the ambulance or the triage room), "tired mother" (they refused to let her go to bed but transferred her and then gave her diamorphine, her baby was born 40mins later, drugged, and went to NICU until his breathing normalised) .  I know dozens of women who've expressed an interest in homebirth and been shut down at their first appointment with either spurious reasons or just a "no, i don't think so" from their Ob.

 

It is true you could say the complication rate doubled.  But i myself fell into that group BOTH TIMES, as you read above (in fact my births would have been included in the study but for the fact that i live in Scotland).  DD1 needed suctioning and oxygen, DD2 (for whom hospital would NOT reduce the risk, given she was a second baby) had a true knot and a velamentous cord insertion.  Both of my babies would, in my local hospital, have spent their first 24 hours in the nursery for observation, on a drip, repeatedly stabbed for glucose levels and away from me.  Neither of them NEEDED that, it would not have improved anything for them, and could only have been traumatic for them.  I have nothing against intervention, i am only against UNNECESSARY intervention.

 

For me that doubled risk is absolutely worth it, because the numbers ARE so tiny, that even if you, like me, end up in the "complications" group, the risk of serious complications is even tinier - yes bigger than in hospital, but in absolute terms still such a tiny increase that you could still know you'd been very very unlucky indeed to have suffered that serious complication.  For other women - well it's everyone's right to make that choice.  There is truly NOTHING wrong with choosing to give birth in a hospital if that choice is able to be made with facts (or at least COULD be made with facts - obviously some women want to make their decisions in other ways and that too is fine, so long as they had access to facts if they wanted them).

 

My DD1 was able to be born without drugs in her system, handled by very few people (most of whom she would be recognising the voices of from prenatal times), fed only my own milk from my own breast, subjected to NO unnecessary interventions and treated at all times with gentleness and respect borne of being "the baby" rather than "a baby" as in the hospital with 30 other babies born that day.  I can say honestly that weighing ALL of that against the fact that she needed some suctioning (with a bulb syringe) and a little oxygen for about 50seconds after her birth i have no regrets whatsoever.

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