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Please let me give a little background before I get to my question...

My husband and I are expected our third child. Our first two were born in the hospital, and both times I was induced. With my first, I was 4 days past my due date and had a lot of pressure from my (horrible) OB to induce, and I agreed to it.
I know, I know. Believe me, I know better now. The OB started with Cervidil, then pitocin. Labor was really hard and I ended up getting an epidural and an automatic episiotomy. I pushed for 2 hours and had a 7 lb, 14 oz baby girl. I knew after that I never wanted to be induced ever again, unless it was absolutely necessary. With my second pregnancy, I found a doula and a new, very NCB-friendly OB. Then when I was 39 weeks pg, we learned that Hurricane Rita was supposedly heading straight for Houston, where we live. They were predicting it to be a Category 5 hurricane and we live on the coastal side of Houston, so we would be under mandatory evacuation orders. After much prayer and discussion with my DH, doula, and OB, we decided to induce. I didn't want to be stuck in evacuation traffic going into labor or be at the mercy of some strange (and probably intervention-happy) doctor in some other city. My OB started the induction with a Foley catheter, then broke my water after several hours, then finally started pitocin to speed things up, as we were racing the clock. My doula was tremendously helpful and even though labor was hard, I ended up delivering my 8 lb, 10 oz baby girl naturally. Pushed for total of 6 minutes and ended up tearing on my old episiotomy scar, even though my OB was trying her hardest to keep me from tearing. We had to evacuate the hospital when she was 18 hours old and ended up spending the next 17 hours in the car.


Anyway, now I'm pg with baby #3 and we really think we want a homebirth. I am only 4 1/2 weeks along right now, but we are trying to figure out what we want to do exactly. We know that in the great majority of pregnancies in healthy women with no complications homebirth is really safer than hospital birth. We know that if the baby or I start showing signs of distress we can transfer. BUT (and here's my question finally), what happens if there is a SUDDEN emergency during birth that needs to be taken care of immediately, i.e. emergency cesarean? What are some examples of this, and how often do they occur? We (especially my DH) really need to put our minds at ease.

Thanks!
 

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True emergencies are very rare...I'd venture to say surprise emergencies that come out if the blue are more rare than you getting into an accident on the way to or home from the hospital.

Nearly all reasons for transfer have warning signs ahead of time...the vast, vast majority of transports are non-emergent.
 

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True emergencies that require an immediate cesarean:

Catastrophic uterine rupture - 0.8 to 3% (depending on the studies you look at). This is nearly unheard of in a normal homebirth, especially with an unscarred uterus (i have found no studies or incidences in my research). But there are documented cases in hospital births were interventions have been used (ie cytotec or pitocin). There are predisposing factors to this - the number one being the caregiver's managment of labor.

Placenta abruption - serious, sudden, unexplained (no risk factors) placental abruption is around 0.5% All placental abruptions are serious, but in the vast, vast majority there is time to do something - again at least 1/2 an hour or so.
Most do not require a cesarean and the baby can be born vaginally.

Vasa Previa - where the umbilical blood vessels for the baby have grown into the amniotic sac making any rupture of membranes risky (either artificial or spontaneous). The incidence is not known - it is very rare. This condition usually has no risk factors and is usually not known beforehand (unless an ultrasound picks it up). If the water breaks through the blood vessels (very unusual) then there would be fresh blood accompanied by fetal distress and an immediate cesarean is necessary. I have seen a few vasa preavias after the fact - upon examination of the placenta. The membranes ruptured spontaneously and I think a woman's body knows when to release the membranes. It is all the more reason to not break the waters artificially.

Prolapse cord - not as dire as one might think. There is time to get the mother to the hospital and in for a cesarean: 20 mins - 1 hour. Also depending on where she is at in labor, sometimes baby can be born vaginally. Again, very rare especially without risk factors (i.e. high, floating baby, breech, polyhydramnios), under 1%.

There are other even more rare maternal or fetal conditions.

I am glad you asked this question. It's important to think about these things and it shows the level of responsibility you have for your body and health care. What I would suggest is that you and your husband consult/interview some homebirth midwives. Ask them this question, really talk about what things can happen and what they would do in any given situation. And think on what you want, in your heart of hearts. What does your gut tell you?
Then, Listen To It!
 

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I agree, both as a professional doula, childbirth educator and mother of 3. I had a hosp birth, a homebirth and a transfer from a homebirth. Every time my baby and I were FINE... many complications have warning signs during pregnancy that can be heralded. Others still give you time to get to a hospital. The ones mentioned above are biggies, but mercifully rare. My baby #3 was at risk for a prolapsed cord, so I decided to deliver in the hospital, an example of seeing and assessing the risk, and making changes to prevent disaster. I hemorrhaged after his birth and was glad to be with nurses and my GP at the time, but again, we had prior warning that I was at risk for that...

Part of homebirth is medical backup to your satisfaction. Research your options, proximity to hospital care if emergency occurs, if that makes you feel better about it. Seeing as you did not have pressing medical issues that lead to your inductions, you will likely do great at home, and will certainly enjoy it more! Good luck
 
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