Mothering Forum banner

1 - 13 of 13 Posts

·
Registered
Joined
·
742 Posts
Discussion Starter · #1 ·
I tried searching the forum for an answer to this, but either I'm searching on the wrong terms or bad at searching (or both) because I couldn't find an answer. I know that I'll have to ask my midwife for her reasons for transferring, but I'm wondering if there is a good "list" out there or if people have their own lists.<br><br>
Specifically, what reasons are there for emergency transfers before, during, after labor/birth? I mean true, call-the-ambulance emergencies.<br><br>
What about reasons to transfer that allow one to go in ones own car?<br><br>
What about reasons to transfer care and plan for a hospital birth before labor/birth even begins?<br><br>
Does anyone have thoughts on what a good % of transfers is? Obviously if I interview someone who transfers 75% of her patients then that's almost certainly bad and if I interview someone who transfers 3% of her patients then that's almost certainly good, but about where do most people draw the line?<br><br>
Thanks!
 

·
Registered
Joined
·
1,099 Posts
Hemorrage could be a reason for transfer, or baby being in a transverse lie and not moving... sometimes failure to progress, typically caused by fetal malpositioning. Fetal distress would be another reason. Sometimes it's just because mom has a feeling that something isn't right.<br><br>
Whether ambulance or your own car would depend on the severity of the situation, whichever it might be...<br><br>
I'd say tranfer rates in the single digits would be what I was looking for, but I don't actually know any hard numbers.
 

·
Registered
Joined
·
3,913 Posts
My midwife had only transferred one other client (in 20 years of practice), and that was due to hemorage. But I think her number was so low because she was very cautious and didn't deliver at home for any slight risk during the pregnancy. We transferred my dd after birth due to severe meconium aspiration.
 

·
Registered
Joined
·
1,696 Posts
cord prolapse would be a reason to transfer. potentially by ambulance.
 

·
Registered
Joined
·
1,823 Posts
On transfer rates - ask the midwife to separate out her transfer rates for primips vs. multips. The multip rate should be much, much lower. (Multips that aren't HBAC, I suppose I should say.) All of the midwives we interviewed had multip transfer rates of 0 to 3%. Primip transfer rates were between 10 and 20%. I personally would feel that a transfer rate for primips over 20% and multips over 5% would make me quite cautious, and I would be asking for much more detail about the reasons for transfer, etc.<br><br>
(Also, be sure to specify you are talking about transfer during labour, not transfer of care prior to labour.)
 

·
Registered
Joined
·
1,522 Posts
My second hb ended up a transfer- a OMG CALL 911-<br>
fetal distress caused by ftp caused by malpositioned baby-<br>
we tried moving him for 32 hour- 19 of it pushing before heart tones repeatedly were lost<br><br>
I asked not to call 911 and went in my own car with dh
 

·
Registered
Joined
·
1,216 Posts
severe shoulder dystocia
 

·
Registered
Joined
·
1,178 Posts
<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>liseux</strong></div>
<div style="font-style:italic;">severe shoulder dystocia</div>
</td>
</tr></table></div>
This certainly would be a reason to call 911, but you most certainly would want to do everything in your power to get that baby out ASAP, and not wait for the hospital. I think SD is an important thing to discuss w/ a care provider.
 

·
Registered
Joined
·
1,216 Posts
Even with everybody working to get the baby out at home, Gaskin maneuvers and all the rest & trying to break the clavicle, there have been some babies that don`t come out by the time 911 arrives and transfer is a dire emergency. Sometimes calling 911 is enough and the baby comes out just needing the extra oxygen that paramedics bring. Thank God this is super rare.
 

·
Registered
Joined
·
7,527 Posts
some things that *might* require a transfer of care before birth:<br><ul><li>breech presentation (if the parents and/or mw feels uncomfortable with breech homebirth)</li>
<li>transverse or other position that either the mom or mw - or both - feels uncomfortable with</li>
<li>pre-eclampsia</li>
<li>persistent high blood pressure</li>
<li>suspected or confirmed placenta previa</li>
<li>suspected placental abruption (usually related to high blood pressure prenatally or before labor)</li>
<li>non-reassuring fetal movement or reactivity</li>
<li>relationship issues between the midwife and client</li>
<li>multiple pregnancy (again, this is dependent upon how the mw and client feel about the situation)</li>
<li>active herpes (again, there is some controversy about this and it is between the client and mw)</li>
</ul><br>
some things that *might* warrant a transfer during labor:<br><ul><li>non-reassuring heart tones</li>
<li>maternal exhaustion</li>
<li>any type of shock - usually related to maternal exhaustion, as in hypoglycemic shock</li>
<li>excessive bleeding</li>
<li>non-progressive labor that both the mw and client feel has gone on too long without some additional assistance</li>
<li>poor positioning (asynclitic, etc.) that doesn't resolve with time and other measures</li>
<li>cord prolapse</li>
<li>signs of infection with or without ruptured membranes</li>
<li>a general feeling of something not being right by the mother</li>
</ul><br>
reasons for transfer after the birth:<br><ul><li>excessive bleeding that does not stop with methods the mw has available</li>
<li>shock due to excessive blood loss</li>
<li>baby's blood oxygen levels not being normal, or breathing being erratic, signs of respiratory distress</li>
<li>some gross abnormality with the baby</li>
<li>retained placenta (and, again, this is based on the mw and client - I have waited up to three hours before starting to really wonder)</li>
<li>partial placental separation - where the placenta starts to seperate, but doesn't completely, so there's massive blood loss, but the placenta being attached partially keeps the uterus from clamping down to stop the blood loss....this is a bad situation that goes horrible quickly. It's sometimes related to poor management - rushing the placenta - of third stage</li>
<li>any sign of rare complications, like amniotic fluid embolism or clotting issues</li>
</ul><br><br>
The vast majority of times, a transfer is done very calmly and without cause for alarm. Sometimes it's maternal exhaustion with a long labor and other times it's heart tones that just don't sound great. I can only think of a handful of times that 911 was employed....one time it was for a surprise breech in which the grandmother called 911 immediately without mine or the mother's desire to do so.
 

·
Registered
Joined
·
630 Posts
I ended up transferred to hospital (from birth center, not homebirth, I'm just browsing...) because of thick meconium staining when my water broke at 9.5cm. Baby aspirated and was in NICU for 12 days. Healthy now, though, thank goodness... but it was definitely a warranted transfer.
 

·
Registered
Joined
·
742 Posts
Discussion Starter · #13 ·
Thank you very much for the information. PAMAMIDWIFE - that was just the sort of list I was looking for.
 
1 - 13 of 13 Posts
Top