I've been thinking of this same topic for my upcoming homebirth, and trying not to dwell on it (happy thoughts, not scary thoughts!
). Glad to know I'm not the only one with the thought of hospital transfer nagging in my head! The hospital I would have to go to (for insurance purposes) has a website that makes the maternity area sound like a Hilton, and yet people only tell me vague stories about how it's really the unideal place in town to go. This is my biggest concern -- getting a sense of what kind of hospital it really is, so I know what I'll be dealing with in the unlikely event of a transfer. Is their website just a marketing ploy? Are their lovely "mother/baby" rooms just a facade? Will they really listen to my concerns like they promise?
I have only a couple of points to add to the thread that have come up in my research (I'm no expert or anything, this is just what I've found). First, regarding getting people to sign a birth plan, everything I read makes a point that birth plans are not legally binding in any way, and that it depends on the hospital and its staff as to whether the plan is taken seriously or laughed at, or even read at all. I would think, especially if the situation is a big emergency where time is of the essence, it would be even harder to get them to deal with a birth plan (and in this instance, perhaps understandably so -- they want to use their time saving you and/or the baby rather than reading a piece of paper). There is a new idea someone on some other thread posted about -- modifying your hospital consent form. Apparently, if you do it right, you can make it so the hospital must ask you (or partner if you're unable) for permission to do any procedure. They won't like this, but it's your legal right, and it might be more efficient than trying to push a birth plan during an emergency. The website to check out is
You have to look under "Resources" then "White Papers". Then look for "Enforcing and Promoting the Rights of Women Seeking Vaginal Birth After Cesarean (VBAC): A Primer." You have to scroll through and look for the part about "Customizing Your Consent Forms: The New Birth Plan." It's totally buried in there. That's the only place I know to find info about this idea.
Anyway, my other thought was the EFM monitor. I want nothing to do with that thing, personally, and I don't see why they can't use a doppler or a fetoscope, but I read another article that makes me wonder if it's worth submitting to in an emergency. Here's the article.
This is a great article, but don't read it if you're trying to avoid negative stories! Anyway, what struck me here is the part about a mother whose baby was in distress, and when the midwifes tried to transfer, the EMT's and then the hospital treated the situation as though there had been no midwife caring for her and started from scratch on trying to diagnose the problem (and botching some things along the way), thereby prolonging the time the baby was having trouble getting oxygen. This happened in a state where midwifery was illegal, so hopefully that's why they were all so ignorant, but we never know. Anyway, when the woman got to the hospital, the midwife couldn't stay (for fear of being arrested), and the woman refused the fetal monitor. In this case, though, had she let them put it on, they would have seen the problem very quickly through their own favorite method and realized she needed a C-section fast. As it was, hospital procedure dragged on and on, and the baby was stillborn.
I still don't know how where I stand on how to handle a hospital transfer (I'm going to talk to my midwife about it soon), but I think there is a certain value in letting them do their thing, horrid as it may be, if it's a true emergency. Plus, the more hospital-oriented midwife I took a hypnobirthing class from made a point that they're more likely to cooperate with you if you don't approach them with a fighting attitude (in your birth plan or in person). If you think about it from their point of view (which believe me, I don't like doing), it's scary to deal with a patient who doesn't want to take your experience and advice seriously. Perhaps this is the importance of the midwife-turned-doula in a hospital transfer -- mediating between mother and hospital so that they don't alienate each other.
I don't want to sound like I'm down on birth plans -- I'm certainly going to have one -- but these are some thoughts I've had about how they'd work in the event of hospital transfer.