I'm planning a home birth, and was seeing an OB up until 24 weeks. I had all prenatal testing, several ultrasounds, and there were no markers for any abnormalities. However, being the worrier that I am, I've still wondered, 'What if there is something wrong with the baby?' The thought of this really doesn't bother me that much--I've worked with special needs children and adults and so it wouldn't completely devestate me to parent a special needs child. I read another post regarding a child being born with a syndrome, and needing immediate medical intervention. How often does that happen? What kinds of birth defects would need immediate help, and what kind of help would they need? We live exactly 2 miles from a hospital and maybe 10 minutes from a great children's hospital.
What kind of birth defects would need immediate medical intervention?
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How often does it happen? If you've had all the standard prenatal tests, and come up with no warning signs, then the chances of having an IMMEDIATE problem after birth are pretty low. I don't know that anyone could give you a statistic, though. Most congenital problems will either show up in testing or they won't present until after a day (or a week or a month, etc.). Your "most common" congenital defects are probably neural tube defects, which are tested extensively for during pregnancy. After that are probably trisomies or other chromosomal abnormalities, which are also tested for during pregnancy. The biggest risk (if you've had testing) is having an undiagnosed completely unexpected congenital defect like a heart defect, and the risk of heart defect is (I believe) about 1% if you do not have a family history. Even so, many heart defects will be found at the 20 week u/s, since that is in fact one of the things they are looking for.
Most commonly, the help that a baby would need would have no underlying "syndrome" to cause it... occasionally a baby will just need help clearing his/her lungs, and a midwife would be completely prepared for that possibility.
But, please keep in mind that if you have a midwife attending you, she should be prepared to handle an emergent situation, and 2 minutes from an emergency room is closer than a lot of people who HB, and even closer than some mamas in the hospital.
ETA - in the case of the mama who started that thread, the problems her LO had are exceedingly rare. I was one of the mamas who responded to her - my LO's problems were diagnosed at the 20 week u/s, and that's why I chose to birth at the hospital, but so long as the 20 week u/s shows nothing this time, I'll be birthing at home.
Most commonly, the help that a baby would need would have no underlying "syndrome" to cause it... occasionally a baby will just need help clearing his/her lungs, and a midwife would be completely prepared for that possibility.
But, please keep in mind that if you have a midwife attending you, she should be prepared to handle an emergent situation, and 2 minutes from an emergency room is closer than a lot of people who HB, and even closer than some mamas in the hospital.
ETA - in the case of the mama who started that thread, the problems her LO had are exceedingly rare. I was one of the mamas who responded to her - my LO's problems were diagnosed at the 20 week u/s, and that's why I chose to birth at the hospital, but so long as the 20 week u/s shows nothing this time, I'll be birthing at home.
I agree with Cristeen regarding the rarity of the baby having a serious defect needing immediate attention that also didn't show up on any screening. I mean, more immediate than the two minutes it would take you to get to the hospital.
I think the chance of that happening are less than the chances of you or the baby being killed in a car accident driving to or from the hospital to birth.
I'm seriously not trying to be flippant or shocking here. I just think that no matter how much we would like to, we just cannot plan and control for every last worst case scenario that has almost zero chance of happening.
You've done everything you can. You've done the prenatal testing. If you have a midwife - she will be trained in handling problems at the birth. And you are close enough to the hospital that you could get there before they would have any really specialized equipment or an OR ready for you (because really, even if you were birthing in the hospital, they would not have the equipment/OR ready in the two minutes in would take you to drive from home).
I think the chance of that happening are less than the chances of you or the baby being killed in a car accident driving to or from the hospital to birth.
I'm seriously not trying to be flippant or shocking here. I just think that no matter how much we would like to, we just cannot plan and control for every last worst case scenario that has almost zero chance of happening.
You've done everything you can. You've done the prenatal testing. If you have a midwife - she will be trained in handling problems at the birth. And you are close enough to the hospital that you could get there before they would have any really specialized equipment or an OR ready for you (because really, even if you were birthing in the hospital, they would not have the equipment/OR ready in the two minutes in would take you to drive from home).
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Some heart defects need immediate medical intervention and some need immediate intubation. But usually the ones that are that severe are detectable on u/s because usually there are whole pieces of the heart missing or completely malformed and it is obvious.
DS2 surprised us with a congenital heart defect called TAPVR. We had a level 2 u/s at 20 weeks with a perinatologist and everything looked fine. He was born at home with a MW and he turned blue when the cord was cut but pinked up with oxygen. He didn't go into any distress until he was 2 weeks old. All babies are born with a hole between heart chambers called a PDA that allows right to left bloodflow so even if something is wrong with the heart this usually helps. It is when it closes that the distress truly starts (around 4 days or so). So even though his CHD was life-threatening he didn't go into distress until his PDA started really closing.
With that being said there are a lot of things that can be missed on u/s and aren't apparent until birth. But being 10 mins away from a great hospital is awesome, I'd feel completely comfortable with that as long as my MW carried oxygen to sustain the baby until the ambulance arrived if needed.
DS2 surprised us with a congenital heart defect called TAPVR. We had a level 2 u/s at 20 weeks with a perinatologist and everything looked fine. He was born at home with a MW and he turned blue when the cord was cut but pinked up with oxygen. He didn't go into any distress until he was 2 weeks old. All babies are born with a hole between heart chambers called a PDA that allows right to left bloodflow so even if something is wrong with the heart this usually helps. It is when it closes that the distress truly starts (around 4 days or so). So even though his CHD was life-threatening he didn't go into distress until his PDA started really closing.
With that being said there are a lot of things that can be missed on u/s and aren't apparent until birth. But being 10 mins away from a great hospital is awesome, I'd feel completely comfortable with that as long as my MW carried oxygen to sustain the baby until the ambulance arrived if needed.
Just want to add that while it is true that the overall chance of a heart defect--any heart defect--is about 1% or a bit less, the occurrence of severe heart defects is *far* lower. The great majority of heart defects do not constitute a need for treatment nor even much by way of increased observation--they are small things that with time are resolved.
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