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Discussion Starter · #1 ·
Has anyone done this? I would like to talk with the nurse managers and some of the local ob/gyns about what they want us to do during a transport. how do they want to handle it? I realize they are less than thrilled about us being around, but the reality is, in my area, at least there are several of us and several hundred births per year.<br><br>
I know from working at the local hospitals, they consider us to be dropping off our 'train wrecks". I'd like to be very upfront and develop a protocol for how to transport. Examples like calling on way, faxing or bringing chart and labs, stay with client?, etc.<br><br>
Anyone do this? Any tips? how ugly was it?<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol">
 

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Just go. Do you know any OBs or the heads of the OB wards? Schedule an appointment. Its to their benefit to have this open communication.<br><br>
they can't be any worse then you're already imagining<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol">
 

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Discussion Starter · #3 ·
I do know several obs, I tried to call through their offices, they made me leave messages, never heard back, just kept being told they are too busy. I'm thinking the next best step is to contact the nurse manager and try to work through her. And put my request in writing.<br><br>
I do imagine it being ugly because I've been on their receiving end before and I worked with many of the obs and nurses when i worked as a nurse, but I still have hope we can at least work together for the patients sake.
 

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I used to work in many of the hospitals in this area that I now do transports to. It is both a blessing and a curse. The blessing is that I at least look familiar and am perhaps known to many of the nurses. The curse is that many of the nurses and physicians alsa think I should know better than to be doing something so dangerous as birth OOH.<br><br>
I started out trying to get in to talk with the docs and the nurse managers. Did not go well. Everyone wanted to know who would be responsible for me because the assumption was I would be bringing in train wrecks like they thought all midwives did, and no one wanted to be sued for a mess that I created and then dumped in their lap. I gave up that idea because I kept feeling like I was asking permission and had to apologize for what I do, when I know that OOH birth is very safe.<br><br>
My attitude has become, and I explain this to my famlies, that we need to be humble and respectful when we go in. The hospital can provide care that I can't. It doen't mean I or the family gives up control.<br><br>
I call ahead, usually talk with one of the nurses and very professionally give report. Sometimes they will put the 24 hour CNM or the OB on the phone instead. When we get to the hospital I always offer the staff the pertinent pages and a summary from the chart so they can make copies for their own purposes. This really helps to smooth things over, so the docs have some history to start with. They can also see that I have charted in real time and that I am being truthful about what we have tried, AROM/SROM/mec., etc.<br><br>
I make it quite clear that I can advise the family and answer their questions but have no authority. Over the last few years I think the docs and nurses have come to see that my clients are well informed and that many of the suggestions the staff is making is something that I have already discussed with the family. They already know what their alternatives are. There have been times when the docs have felt some thing was necessary like an IV or an epidural and think these natural birth people are going to refuse all intervention. However, what they usually get is the family agreeing it is a good idea because we have already discussed it and I strongly suggetsed it would be necessary.<br><br>
It may just be the luck of the draw, but more often than not our open and respectful attitude nets us a very understanding nurse and doctor. Postpartum is always another story, but most of my families have a good birth experiences in spite of the circumstances surrounding a transport. They feel that they are in contol of making the decisions and I stay with them as a support person.<br><br>
Our VBAT (vaginal birth after transport) rate is better than 90%.<br><br>
Incidentally, I did have one doc you took me down the hall after the birth and proceeded to tell me how irresponsible I was. She told me I shouldn't do OOH birth w/o a consultant to transport to and that I would be getting a phone call from the nurse manager about the transport. I very politely told her that would be great because I had been trying to get in contact with her for some time about transports protocol and she hadn't returned my calls. I made a choice during the heat of her criticism to not get defensive but to acknowledge her concerns. She is still very brusque (just her personality), but I hope she now recognizes that I am being as responsible as I can possibly be given the circumstances.
 

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learn how to give "report" if you don't know how, talk to some nurses you know and learn from them and practice giving report-- have your records with you with labs and any tests like GBS that you have done- as well as a simple labor progress sheet- and be ready for them to want to make copies-- if you can call ahead of time even when we have transfered by ambulance we have called from our car on the way-- just to let them know you are bringing someone in with and what to be prepared for-- when we have gone in by car we definately call from the house but just before we actually leave-bad form to call saying you are going to come in (like for pain meds) and then end up having the baby before you can leave <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/wink1.gif" style="border:0px solid;" title="wink1"><br>
depending on where your clients live and how far it is from a neonatal specialist, you may want to find out if - there is a state perinatal transport system set up- if there is then you will want to be to a "training " session with them-and they are really set up to listen and problem slove as much as possible your emergent transfer problems some births we call both the perinatal transport folks and the local ground transport system and they get a heliocopter in the air or a ground crew with a neonatal intensive care nurse as well as a perimedic ---<br>
the trouble with docs having meetings with you is fear that it will be construed as "back-up" and then open them to liability--- so in recent years I have not seen a doc who has been willing to talk over what they want in a transfer like being called at home- as opposed to waiting for the hospital to call--<br>
now there are some things I want to cobble away at that have to do with the the ambulance system(different than the perinatal system) because it is real hit and miss if they will listen or even act competently -- probably taking CPR and neonatal resuscitation or doing some sort of inservice for them is probably the way in<br>
the other thing I do prepare prenatally -- we discuss if we have to transfer, and then there is some discussion before we leave as well-- and one take home point is that we are going in to GET an intervention-- certain interventions include other interventions- they go together like drugs and monitoring - and if "risk" status has changed- SS of infection or heart rate changes then continious monitoring is standard of care -- vitamin K would be prudent if vacuum is used or if the baby is resuscitated... preparing parents for why a procedure includes other things that they would normally opt out of is an important part--- and may reduce the amount of struggle that could happen-- what you really want is for them to treat your clients humanely and to listen to their wishes and helping parents understand when something is reasonable or not before hand can help to reduce strife in an already stressful time-- if there is any way to talk to the nurses on the side and point out how much parents are going through get them to understand how different it is for them and that their expectations were completely different than what they are now getting-- try to get them to take your parents under their "wing" understand that there is a huge "cultural" difference for people who desire to be in the hospital and people who want to have a home birth.<br>
try to remember nurses names, making inroads takes time and face it they don't see us unless there is a problem usually so they do have a stilted view- we send flowers and thank you cards to nurses and docs who help us--<br>
you are there to support the parents but also to help them to transition into the care provided try to give the folks at the hospital the benefit of the doubt - they are there to help-think the best you can of them
 

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and I have chose a hospital birth ( unmedicated and left 4 hours after) for third.<br><br>
I am one of the homebirthers you might say was corrupted by the system after becoming a part of it. No, I think it changed my view of reality.<br><br>
But I can give you some pointers on dealing with staff. I am just about the best person at my hospital to get if a mom comes in after a home birth transport. Yet, I have been treated horribly by one midwife who in everyway made me feel like the enemy. Most midwives I have met have been very professional in how they deal with us.<br><br>
Most of the time, yes, of course, call ahead or the doc you talk to will but we should know she is on her way so we can prepare for her as we would any other labor patient. Especially because a home birth transport mom may have become high risk and being efficient in her care could give her safer care.<br><br>
As the other poster said, I appreciate a report from the midwife VERY much. I am not hostile toward midwives at all even though I no longer would give birth at home myself. Even if the nurse IS hostile, your mom is your priority, not her feelings her agenda, your feelings or your agenda. So everyone should be professional and communicate all the things the hospital needs to know to care for her.<br><br>
I guess that is my main message. Don't assume the nurses are the enemy. If you start out defensive it just reinforces people's attitudes. Most nurses TRULY think people who choose home birth know hospital birth is safer but are choosing an "experience" over safety. I know when I had my daughter at home I thought I was choosing the safest method of birth. I know that the VAST majority of home birth moms are choosing homebirth because they have looked at the evidence and think it is safer. Now, I don't see it that way anymore. But I do not doubt their (or perhaps your)sincere difference of opinion. I also remember my biggest fear was transport, and being "judged". I try very hard to let a mom in my care know I too once chose homebirth, and I don't tell her I changed my mind! I try to let her know her choices are respected and I know she wants what is best for her baby and this is scary.<br><br>
I know you could always get a nurse on a crusade. I know I meet midwives on crusades. I don't like crusades! It's about the mom and baby, and family, and most nurses, if treated with respect, will be pleasantly suprised by a non hostile and thorough report. The others you will never change and I hate working with them too.
 

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Thanks for the question, and for all these great answers--<br><br>
I have not considered trying to talk to anyone in advance to set up protocols for transfer of care...but I have considered these things for myself and do discuss with families before birth. It would probably be impossible for me to get the time and exchange needed from the hospital end, to make advance and professional arrangements, partly because I serve a fairly wide area and simply am dealing with a LOT of possible hospitals and docs. Partly also because being illegal, I'm just not willing to out myself that much--tho there are friends and sympathisers in many places. But it is wise, I think, to have a plan in mind--such as being ready with a report and pertinent records, which make both me and my clients appear more sane, as well as easing the transition quite a lot in many cases.<br><br>
I guess I'm saying that even without OB/nursing staff input and open exchange on the idea of developing transport protocols, it is certainly possible to think about this, and develop what are probably professional and sane protocols for oneself as a midwife--and to make sure clients have some understanding of all this in case it becomes needed.
 

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<div>Originally Posted by <strong>MsBlack</strong> <a href="/community/forum/post/8237252"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Thanks for the question, and for all these great answers--<br><br>
I have not considered trying to talk to anyone in advance to set up protocols for transfer of care...but I have considered these things for myself and do discuss with families before birth. It would probably be impossible for me to get the time and exchange needed from the hospital end, to make advance and professional arrangements, partly because I serve a fairly wide area and simply am dealing with a LOT of possible hospitals and docs. Partly also because being illegal, I'm just not willing to out myself that much--tho there are friends and sympathisers in many places. But it is wise, I think, to have a plan in mind--such as being ready with a report and pertinent records, which make both me and my clients appear more sane, as well as easing the transition quite a lot in many cases.<br><br>
I guess I'm saying that even without OB/nursing staff input and open exchange on the idea of developing transport protocols, it is certainly possible to think about this, and develop what are probably professional and sane protocols for oneself as a midwife--and to make sure clients have some understanding of all this in case it becomes needed.</div>
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It is a shame that fear for yourself would stop you from giving report to the next person to deliver care to your client. Speaking from the hospital side, it endangers the client if the hospital doesn't have a chance to ask questions and get a complete picture of what has happened before she came to us.<br><br>
It isn't that I don't understand that there are state a midwife could go to jail. But I have gotten report from midwives in a state where the midwife was NOT licensed and it was the nicest and best report I ever got and I was more impressed with this midwife than some of her licensed colleagues.<br><br>
I guess you have to weigh the risk to yourself vs the risk to your client.<br><br>
I have been in the birth world for 27 years now and some of it in home birth world and most of it in hospital birth world. When I was in the home birth world one of the things that drove me out was the frequency with which I saw the midwives lie about thing like how long the membranes were ruptured. I also became frightened of being a home birth attended when the midwives I knew, and had glowingly showed me a film of the Gaskin manuever, had a baby with a shoulder dystocia die after trying everything, including that. Not that it couldn't have happened at the hospital. But I knew I didn't EVER want to face what they faced..with so little support.....from the public and without a staff behind me to try to save the baby once it did come out. I was a Bradley teacher a year later this mom called me and wanted a class...I think really she just wanted to talk...but it was clear she really blamed the midwives just like most of the time in a tragedy like that in the hospital the doctors are blamed. Things like that will haunt you no matter where you are...<br><br>
Sometimes I explain it like this. A mom choosing a low risk home birth has a very tiny tiny chance of a tragedy happening that could have been prevented/treated in a hospital. Homebirth is a reasonably safe choice for the right woman in the right hands.<br><br>
But from the providers point of view....if you are busy you will see thousands of births...and sooner or later you will have a baby or mom with something that would have likely had a better outcome in the hospital setting. 1:1000 becomes a certainty if you are the care provider over ten years? Are you emotionally able to deal with that? You can intellectually know that you might have saved hundreds of unneeded C/S and some of your babies and moms were saved hospital acquired infections and iatrogenic causes of loss( such as a medication error). But the reality will be you will have to face that mom, who, as is normal in the grieving procces, has a good chance of blaming herself and/or you.<br><br>
Having held, photographed, cried over, cried with parents, footprinted babies who were stillborn...it is hard enough as a nurse. I think it would really be a million times harder as a midwife. So that is why I stayed with in hospital birth. Because those images and memories, for me, would overwhelm I know the statistics.
 

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I would love to start another thread about mamabearings last post and suggestions, but to keep on topic I just wanted to say that mothercats and mwherbs suggestions are awesome. I will soon be starting on a OB floor as my first nursing job and I think that I will have A LOT more suggestions then (my background is in OOH birth for the last 5 years). I think it may take a little educating as well as touching base with providers. Much of the misunderstandings come down to ignorance and fear. Open and honest communication is key. But, many nurses and OBs have very skewed information, that I know for sure.
 

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A lot of hospitals in Australia have a policy in place for dealing with hb transfers and while they don't adhere to them most of the time, they do exist. I wonder if you may find some hospitals have them already? They usually read like a mission statement to be nice to mws and their clients when they arrive and a friend of mine carries one in case of tf to her local hospital where she can wave it about as part of her desire for co-operation. "Look, Dr VIP has said we should all work together, so let's!"
 

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I like the idea of quoting the mission statement.<br>
There have been days when I have been in the hospital and read those darn things in the elevators. I wished I had a copy so I could say, "Cooperation and respect are part of your mission statement. Can't we all remember why we're here?"
 

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Discussion Starter · #12 ·
I should clarify that I am a nurse and have worked women's health so I don't go into the hospital thinking they are the enemy. In fact, one of the reasons I want to talk with them is to make the transport smooth, try to not have them feel like the 'train wreck' situation and to understand how they handle it so i can prepare my clients.<br><br>
i am also interested in finding out their protocols for GBS since I have heard if not tested they will treat as positive and keep baby for 3 days. That's why i started testing everyone, treating, then retesting.
 

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Mamabearing--<br><br>
This is what I actually said, which you seem to have missed:<br><br>
"But it is wise, I think, to have a plan in mind--such as being ready with a report and pertinent records, which make both me and my clients appear more sane, as well as easing the transition quite a lot in many cases. "<br><br>
I did NOT say that out of a wish to protect myself legally, I would fail to provide a report. Such a thing, having a direct bearing on the life and health of a mother and her child, would be unthinkable for me--and in fact I am quite clear from the outset with clients that I will do everything in my power to aid transport should that become necessary, EVEN THAT WHICH COULD HAVE MY ASS THROWN IN JAIL.<br><br>
I also do not appreciate your assumption that I--or any homebirth mw--is emotionally unprepared to face disaster or loss. Nor the assumption that one is somehow less likely to experience those disasters and losses in the hospital than at home. Nor the assumption that confronting such awful matters is somehow easier in the hospital, under the aegis of 'well at least by being in the hospital, we did all the best of everything available'. Apples and oranges--do the research, as I have done and expect all my clients to do, on relative risks.<br><br>
As for your post in general, I agree that it would be a good starter for another thread.
 

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Discussion Starter · #14 ·
Wow, not sure what happened, but I think it's safe to say that most homebirth midwives are prepared for emergencies and worst case scenarios. I carry all kinds of equipment, more than I need, but being a nurse, I think I tend to think of everything that could go wrong and be prepared.<br><br>
I also discuss right away the possibility of transport, go over the pros and cons of local hospitals. I have all their numbers as well as the coroner for each county, the neonatalogist, perinatalogist, emts, etc.<br><br>
And unfortunately, I have been at births without a good outcome. I am totally prepared emotionally, I feel it is an honor to be with the woman, family and baby at such a powerful, sad time. In fact, people started asking for me to be with them if they trisomy babies since I had done some. I have a whole procedure including lots of pictures, footprinting, hair, etc. even if it is a very early birth.<br><br>
But that's not what this thread is about. What I wanted to know is whether meeting with the nurse manager and doctors to discuss transports would be the best option. Whether they would prefer to meet in advance so they can tell me how they would like things done, how they want to handle it. Each doc, each hospital has different policies and procedures.<br><br>
Maybe another thread, but I think it would probably get ugly real quick and get shut down, but you can try I guess...
 

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<div>Originally Posted by <strong>MsBlack</strong> <a href="/community/forum/post/8244787"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Mamabearing--<br><br>
This is what I actually said, which you seem to have missed:<br><br>
"But it is wise, I think, to have a plan in mind--such as being ready with a report and pertinent records, which make both me and my clients appear more sane, as well as easing the transition quite a lot in many cases. "<br><br>
I did NOT say that out of a wish to protect myself legally, I would fail to provide a report. Such a thing, having a direct bearing on the life and health of a mother and her child, would be unthinkable for me--and in fact I am quite clear from the outset with clients that I will do everything in my power to aid transport should that become necessary, EVEN THAT WHICH COULD HAVE MY ASS THROWN IN JAIL.<br><br>
I also do not appreciate your assumption that I--or any homebirth mw--is emotionally unprepared to face disaster or loss. Nor the assumption that one is somehow less likely to experience those disasters and losses in the hospital than at home. Nor the assumption that confronting such awful matters is somehow easier in the hospital, under the aegis of 'well at least by being in the hospital, we did all the best of everything available'. Apples and oranges--do the research, as I have done and expect all my clients to do, on relative risks.<br><br>
As for your post in general, I agree that it would be a good starter for another thread.</div>
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I sincerely apologize I really did misinterpet what you said.<br><br>
You misinterpeted too a lot of what I said. I was talking about ME. I have had LONG talks with homebirth midwives and yes, they know, given time, they will have to confront a disaster.<br><br>
I said, not speaking for you, but for me, I was planning to be a midwife at home, that I was frightened by the prospect of a neonatal resuscitation at home after seeing the difference in a hospital. I am frightened of working in a hospital without a NICU frankly when I see the difference in skill between someone who does it everyday vs once in very long while.<br><br>
I completely and totally respect you for doing what you feel is best, and being braver than me and being willing to take the risk of "being thrown in jail".<br><br>
I did read it wrong and I am truly sorry. I did not mean to insult you or anyone.<br><br>
PS I want to address this too<br><br>
"I also do not appreciate your assumption that I--or any homebirth mw--is emotionally unprepared to face disaster or loss. Nor the assumption that one is somehow less likely to experience those disasters and losses in the hospital than at home. Nor the assumption that confronting such awful matters is somehow easier in the hospital, under the aegis of 'well at least by being in the hospital, we did all the best of everything available'. Apples and oranges--do the research, as I have done and expect all my clients to do, on relative risks"<br><br>
I really know that most are prepared emotionally. I said "I" knew I couldn't be.<br>
I think I am infinitely more likely and probably have seen more disasters and losses in the hospital. I work in a high risk center. Yes, certain parts of confronting a disaster are easier in a hospital...but for me it isn't that I think it is only that the best of everything is available. If you know you are most likely to have a disaster it IS comforting to have a NICU behind you. It doesn't make footprinting a dead baby easier or facing the parents easier and I don't know that it is easier for me in a hospital than a midwife at home. What I do know is it is less likely to make the paper, I am less likely to go to jail, and that in general, society will support me more. I also KNOW that is horribly unfair.<br><br>
In terms of research, in my next post I tell of my own homebirth experience, which was wonderful by the way, and that yes, my midwives unflinchingly discussed relative risks. But part of the reason I want dialogue between the two camps is at the extremes of both camps are people who I believe will only look at research that supports what they already believe. I am a rare person who came to change my mind. I have seen it go the other way too.<br><br>
Anyway, I feel awful that I thought what you were saying is you would leave a mom in danger because you might go to jail. You are right, that is how I read it. And I am truly and deeply sorry and respect you so much standing by them despite the personal risk you take in doing so. That shows tremendous integrity and I applaud it.<br><br><br>
One more edit...what I said ALL WRONG...I was asking...not accusing...really!<br><br>
"But from the providers point of view....if you are busy you will see thousands of births...and sooner or later you will have a baby or mom with something that would have likely had a better outcome in the hospital setting. 1:1000 becomes a certainty if you are the care provider over ten years? Are you emotionally able to deal with that? You can intellectually know that you might have saved hundreds of unneeded C/S and some of your babies and moms were saved hospital acquired infections and iatrogenic causes of loss( such as a medication error). But the reality will be you will have to face that mom, who, as is normal in the grieving procces, has a good chance of blaming herself and/or you. "<br><br>
The point I was trying to make was how do you cope with it...in question form...not accusation form. I was also saying it scared me out of homebirth. Because I know that emotionally its just hard enough when you have the vast majority of public opinion on your side. But looking back...my words we are you prepared? Not I wasn't prepared. But my question really was more...how do you cope with it.<br><br>
Actually, there is a post here from a doula who gets a lot of advice about how to cope. And it looks like the same way nurses and doctors in hospitals do....crying...pulling over on the way home...questioning yourself...journaling.<br><br>
Again, I respect you for standing by the moms you work with despite risk to yourself. I hope somehow my sincerity in that comes through the words I have chosen.<br>
"
 

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<div>Originally Posted by <strong>Maggi315</strong> <a href="/community/forum/post/8246942"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Wow, not sure what happened, but I think it's safe to say that most homebirth midwives are prepared for emergencies and worst case scenarios. I carry all kinds of equipment, more than I need, but being a nurse, I think I tend to think of everything that could go wrong and be prepared.<br><br>
I also discuss right away the possibility of transport, go over the pros and cons of local hospitals. I have all their numbers as well as the coroner for each county, the neonatalogist, perinatalogist, emts, etc.<br><br>
And unfortunately, I have been at births without a good outcome. I am totally prepared emotionally, I feel it is an honor to be with the woman, family and baby at such a powerful, sad time. In fact, people started asking for me to be with them if they trisomy babies since I had done some. I have a whole procedure including lots of pictures, footprinting, hair, etc. even if it is a very early birth.<br><br>
But that's not what this thread is about. What I wanted to know is whether meeting with the nurse manager and doctors to discuss transports would be the best option. Whether they would prefer to meet in advance so they can tell me how they would like things done, how they want to handle it. Each doc, each hospital has different policies and procedures.<br><br>
Maybe another thread, but I think it would probably get ugly real quick and get shut down, but you can try I guess...</div>
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I can tell you a little about the long ago shoulder dystocia. It could have happened in a hospital too. I doubt from the length of time of the shoulder dytocia that even the best resuscitation would have saved the baby. Since you are a nurse you know that it can happen there too.<br><br>
When I had my daughter at home my midwives were like you. They really laid it on hard about the risks and I remember feeling...well, can't you just promise me like all the home birth books I read seem to that there is no risk. But they were good, they said there are rare things that happen at home that would be better in a hospital. Just as the reverse is true. So I NEVER meant that all midwives approach it with rose colored glasses. I just meant I couldn't deal with ( emotionally ) the prospect of jail. I couldn't deal with only having a few people to start a resus and then KNOWING the ambulance would know tons less than I do about how to safely get the baby to the best team. There I would argue, that in all practicality, if you don't do something often enough, you won't be as good as someone who does. And resus is scary when it isn't just a couple puffs and it takes practice, coordination teamwork and experience and backup. I don't argue though that lots hospitals do might make you more likely to NEED the resus.<br><br>
I think that the original poster was talking about dialogue and transport. I guess I got more into my personal reasons why I didn't choose to be a homebirth midwife. But I think that knowing where I am coming from gives me some credibility as not being the typical nurse who knows NOTHING about homebirth or why it is a reasonable choice. But yes, everytime I ever try to talk online with the homebirth community it turns into everyone feeling attacked. I think different people can review the same literature, and have different backgrounds, different life experiences, and varying degrees of bias on both sides....<br><br>
but the sad thing is we can rarely talk to eachother.
 

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mamabearing--<br><br>
Thanks for taking time to clear that up. You are so right, I went from your assumptions into my own, and I apologize for that...I did not read you as asking a serious question (coping w/disaster, eg), but tossing out a challenge. In fact it is a very good question for any midwife to be able to answer--or any doc or nurse, for that matter, though as you point out, for them there is more support in place--because life and birth being what they are, we WILL face those losses and disasters one day. And it is certainly true that each provider of care has to find the workplace that works best for them, given their nature. I was just talking to a geriatric nurse the other day; she said that she'd been very attracted to L&D at first, but realized that she would never be able to deal with infant/maternal death...so she went into geriatrics, where the deaths would seem, to her, far more normal and ok.<br><br>
Anyway--it seems we agree that it is important for all concerned that upon transport, being willing and able to provide records and report as needed (I've never been asked for a written labor report, but have offered basics and then answered questions as asked...and do provide copy of lab repts as appropriate).<br><br>
As a homebirth midwife, I think that perhaps I take more time and care to be sure that people understand those relative risks than any med provider does. And to say, generally, we have no guarantees, babies do die sometimes, moms/babies get sick despite our best efforts. In my VBAC informed consent, I state the risk of uterine rupture, and add "but if you are THAT ONE out of x, it makes a huge difference to YOUR family". I've never heard of a woman being told that her chance of death by csec is 3x greater than w/vag birth, for instance.<br><br>
Bringing this back to the question at hand, with or without advance protocols worked out with particular providers/hospitals, it is indeed possible to accomplish transfer from homebirth in a safe, sane, courteous and professional manner. While at times I have dealt with marvellously professional and courteous staff, I have also dealt with great big nasty controlling docs/nurses with an axe to grind against mws and homebirth fams...then, the main task at hand for me, the most important thing I do for my fams is to help staff remember their missions. In my case (or any other illegal mw), I have to be prepared for 'whatever', and do not really have the luxury of creating agreed, advance protocols. In my case, I have to have my own protocols, and help get the fams to think about these things in advance, and have the skill of flying by the seat of my pants if we meet the 'wrong kind' of staff that particular day. (and my transport rate is low, thankfully)
 

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<div>Originally Posted by <strong>MsBlack</strong> <a href="/community/forum/post/8248657"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">mamabearing--<br><br>
Thanks for taking time to clear that up. You are so right, I went from your assumptions into my own, and I apologize for that...I did not read you as asking a serious question (coping w/disaster, eg), but tossing out a challenge. In fact it is a very good question for any midwife to be able to answer--or any doc or nurse, for that matter, though as you point out, for them there is more support in place--because life and birth being what they are, we WILL face those losses and disasters one day. And it is certainly true that each provider of care has to find the workplace that works best for them, given their nature. I was just talking to a geriatric nurse the other day; she said that she'd been very attracted to L&D at first, but realized that she would never be able to deal with infant/maternal death...so she went into geriatrics, where the deaths would seem, to her, far more normal and ok.<br><br>
Anyway--it seems we agree that it is important for all concerned that upon transport, being willing and able to provide records and report as needed (I've never been asked for a written labor report, but have offered basics and then answered questions as asked...and do provide copy of lab repts as appropriate).<br><br>
As a homebirth midwife, I think that perhaps I take more time and care to be sure that people understand those relative risks than any med provider does. And to say, generally, we have no guarantees, babies do die sometimes, moms/babies get sick despite our best efforts. In my VBAC informed consent, I state the risk of uterine rupture, and add "but if you are THAT ONE out of x, it makes a huge difference to YOUR family". I've never heard of a woman being told that her chance of death by csec is 3x greater than w/vag birth, for instance.<br><br>
Bringing this back to the question at hand, with or without advance protocols worked out with particular providers/hospitals, it is indeed possible to accomplish transfer from homebirth in a safe, sane, courteous and professional manner. While at times I have dealt with marvellously professional and courteous staff, I have also dealt with great big nasty controlling docs/nurses with an axe to grind against mws and homebirth fams...then, the main task at hand for me, the most important thing I do for my fams is to help staff remember their missions. In my case (or any other illegal mw), I have to be prepared for 'whatever', and do not really have the luxury of creating agreed, advance protocols. In my case, I have to have my own protocols, and help get the fams to think about these things in advance, and have the skill of flying by the seat of my pants if we meet the 'wrong kind' of staff that particular day. (and my transport rate is low, thankfully)</div>
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Thank you for accepting my apology. I am sure I would be very happy to care for one of your clients and we would get along fine! And I know there are staff that will treat any non nurse midwife badly...not most where I work..but a few would be awful. I try to "educate" them but they are not open to the possibility they may not already know everything there is to know.<br><br>
Your analogy of the geriatric nurse is great. Isn't it amazing how one person's fear is one person's passion? I was always fascinated by, but terrified of, adult ICU. I can't stand the idea of seeing that much tragic death, so regularly. My adult (the one born at home) well her 19 year old life was saved after a car accident by paramedic, ER and ICU nurses and doctors and I am so glad there are individuals who find that work their life's calling.<br><br>
For me, I still love normal birth the most. But I also know I am very good with high risk and like the intellectual challenge. Though I may be caring and good with loss, it takes a huge toll on me, so I am glad it is very infrequent, even in our high risk hospital. It is the right place for me I guess....but never where I thought I would be 27 years ago when I decided to become a midwife...still an RN...a year of night shifts and seeing how little autonomy CNMs usually have, and make less than the nurses....sort of made me see that for me and my family...this is the right choice.<br><br>
My respect to you and this was just what I was seeking. An intelligent conversation with a home birth midwife about what it is like to be you.<br><br>
Thank you.
 

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I guess you could try to talk to the nurse managers- I know that sometimes direct contact ends up back firing in that you are not going to change your protocols in response to their concerns... and then when you show up with someone with an unrelated problem but they want to take you to task because they can see by the record you didn't take their advice... nurses can have interesting imput but you are a provider- and your provider decisions may take them into consideration but - your choices are made from a completely different skill set--<br>
here they keep every baby that transfers in 48 hrs regardless of GBS screening status- this is a particular hospital's ped staff dictating it-- just how it goes... the other big hospital in town has an earlier release policy- and mellower on their visitation but not always the closest place-- and the small hospitals can be nightmares-- knowing what level nursery they have can save you some time - but if you use an ambulance not always your call -- we had a situation where we had done everything to get a retained placenta out and it wasn't coming and only seeping a bit well the bigger closer hospital was on diversion- and they wanted to take mom to a HEART hospital! we said no they can't do anything more than what we have done she needs and OB and a surgery -- when we said no- they looked at us like what do you know all the docs are like superman! but evidently they passed on what we said to disbatch and they re-routed to the hospital on diversion...<br>
so something that some of the CNMs do is to take THEIR protocols bound probably more than 10 pages worth and talk to the head of OB could be done over lunch or a short office visit- this is not gone over page by page but just given along with a bit f discussion that you will be bringing in people from time to time- sometimes for pain relief or sleep and augmentation .. and sometimes emergent and -- the pain and sleep stuff is about time and exhaustion because we are walking that balance- I recommend only doing this at friendly or bigger hospitals because they will welcome you - smaller hospitals can end up being a competition and problematic... If you know someone or have worked at the hospital then you know what they might want or can talk to the folks you know--
 

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My clients and I had a bad expereince at one of my local hospitals, we were treated very discrespectfully by the staff.<br><br>
It took me a long time, but I finally addressed it with the head nurse because I did not want anyone to go through that expereince again. I made an appointment to talk to her and to bring a client who wanted to check out the hospital in case of transport. I brought multiple copies of information about homebirth and CPM's.<br><br>
It was a success, the NM was very reseptive and appologetic to the point she asked me to write a transport protocol for her staff. She even enquired about having a copy of my clients charts on the ward = but thier legal council said that was a no-can-do. We even discussed the possibility of me doing an inservice about hb at one of the staff meetings.<br><br>
I wanted to mention also that we had an event at one of the big university hospitals about transport with Ina May Gaskin. It was truly an eye opener to witness the ignorace displayed by the students and staff..."do you all take bp's?", was one of the questions. I feel personally that it is so important to meet and reach out...I offer a hospital visit and meeting with head nurse to my clients closest hospital if they want. I have never been turned down to meet with a NM. Doc's I have never successfully had meetings with...though I have not tried very hard.<br><br>
MWHerbs, a question...I did not really understand what you wrote about neonatologist and state team, etc... can you clarify this for me? Ie, I would expect that when you call into a local hospital with a problem baby they make the emergency transport arrangements to a higher level center if nessesary? Sorry, I am tired!<br><br>
THanks for this great discussion! Paige
 
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