"I or my Baby would have died"

[Amieee]

Cuz I Care's thread made me think of this.
I hear this a lot, in regards to complications in childbirth and not being in the hospital.
I have been under the impression that my midwife can handle just about anything at home, except performing an emergency c-section.
As I do have a homebirth coming up soon, can someone who knows maybe tell me exactly what types of complications would not be able to be handled at home? I don't mean ones that are obvious beforehand. I mean the ones that show up during labor or delivery. I am starting to get a bit anxious and am wondering what the "what if's " are that I really need to be concerned about.
The friends I have who have said this are usually talking about cords wrapped around some body part, or hemmoraging of the mom, or meconium in the fluid. I don't see why one has to be in a hospital to deal with these issues.
Maybe I am ignorant?

On another note, though, I had not wanted to tell lots of people for fear they would just be waiting for something to go wrong or think we were being irresponsible becasue some people just don't understand what is involved. Now, the cat is out of the bag, and with the exception of my mom, who is waiting to rush us to the hospital, most people have not said "Aren't you worried about X" or "What if Y happens wouldn't you want to be in the hospital" No the main question I have gotten is "OMG, Does that mean you can't have an epidural?????? " :rolleyes:

Edited to add that when I posted this, I didn't realize how there were several other sort of related threads elsewhere. I hope I didn't step on anyones toes or make anyone feel bad.

[djk42]

When I got the "epidural" ? I gave them a blank look and asked why anyone would want one. Then they looked at my other two kids and ask if I had one with them and I said, "No, I thought most people didn't," which is true- I didn't know until after two kids that 80-90% of women use drugs in birth, even though the AAP has not approved epidurals for use in childbirth!!!

hemmoraging of the mom: my midwife carried drugs for this, but I requested to not use them until after we had a chance to breastfeed a second time, and by that time the bleeding had slowed enough she said I was okay. The nurse stayed with me for 6 hours cleaning up, doing paperwork, etc, and she wasn't leaving until my blood flow was normal. :)

cords wrapped around some body part: the midwife would assess the situation, see if the baby could be turned or cord unwrapped, then if the baby seemed to be in danger might call for a tranfer- same with footling breech

meconium in the fluid: this is only an issue if the baby inhales it.. none of my kids did and I think two of them had it (not sure about Beth, she could have too- they were more into yelling at me than telling me anything), all of mine were "late" and had the increased risk of meconium.. most midwives are trained in infant CPR and carry oxygen tanks and suctioning tools for minor cases, and she would have someone call for an ambulance for severe cases while she does what she can


I think a lot of "the doctor saved them" stories are misconceptions. My bil told me about a mom who almost died because the baby was breech and you can't deliver a breech baby, but their OB did a c-section and saved their lives, so they are so glad they picked the same OB. Then our other sil had a vaginal incomplete breech. :D She did have a lot of bleeding and other problems, but that was because the baby was born through her cerclage stitch, not because she was breech.

Of course, there are times when doctors really can save lives, as much as there are times when even the best doctor cannot do anything. For me, homebirthing has a lot to do with my faith in God. God is the giver of life, not the hospital. I have faith that if my child were to die, it would be for the best somehow. That doesn't mean I would be okay with it, but that I trust Him to know what is best in all parts of my life. We learn more every day.. did you know that 5 babies a year died on the way home from the hospital in car crashes before car seats were required for check out? You have to ask why God would allow a safe hospital birth if the baby wouldn't even make it home.. but for some reason it was for the best. I don't have to know His reasons to trust Him.

[StephM]

What a good question. I am looking into homebirth for this baby, and feel pretty confident about it. I truly feel that w/out any problems this pregnancy, both myself and baby would be safer at home. The comments I have had from people "We both would have died" have come from people w/ diseases and problems in the first place and carrying babies with known birth defects. Well, duh, they belong in a hospital.

But I have to say, I am intrigued by your question and I have thought the same thing in one form or another. I can't wait to read our experienced homebirthers' responses!

[hedra]

Okay, I am not an experienced homebirther. But I am a compulsive researcher who knows where to look for data. :)

The vast majority of the 'the baby or I would have died' situations are not time-critical items. True cephalo-pelvic disproportion? Transverse breech? Signs of abruption? Meconium aspiration? As long as someone is paying attention to the signs, you get transferred before or after the birth, and you are all fine, 'saved by modern medicine'.

In those cases, Medicine/surgery is used, but it isn't usually necessary to do a c-section instantly if your care provider has been paying attention most of the time. Even post-birth eclampsia (sudden onset) is managed with meds, that the midwife could easily have available. Abruption, cord prolapse, and uterine rupture are probably the worst emergencies. But they are also really rare. (using the CDC 2000 stats, abruption rates for the US were 5.5 in 1000 births, cord prolapse was 1.9 per 1000, and rupture isn't even listed because the reporting is so often incorrect - only about 40% of reported cases are confirmed to be actual ruptures, according to a preliminary study, so all data is questionable) Source: http://www.cdc.gov/nccdphp/drh/mh4.htm According to the info I found, in most cases of abruption, it is moderate and indicated by clear symptoms and fetal distress. Again, in other words, you can tell it is happening in time. Even cord prolapse is best managed by methods readily available to a midwife - all-fours position, pressure on the baby's head (reaching in and holding it away from the pelvis, that is), and oxygen to the mother (which I recall homebirth midwives generally have handy), and c-section is not always indicated (depends on degree of dilation). In a hospital setting, these are all life-threatening issues. Same for a home birth setting. The management of them does not require hospital staff/equipment instantly in most cases.

The vast majority of things that are 'issues' are either identifiable well before hand (so you can be transferred in a timely manner) or are managable in a home setting with an experienced care provider. BTW, gentlebirth.org has a page called "Response to a Homebirth Complication or Tragedy" that covers a lot of these topics.

Basically, I can't think of many things that cannot be managed properly at home with appropriate meds available, and someone who is paying attention the whole time. Home management may include a decision to transfer to the hospital, but that's fine, right? Modern medicine 'saved' my or my son Gabe's life, quite likely. That doesn't mean that it was wrong, bad, or irresponsible of me to have started my labor at home or continued it at the Birth Center. It means I needed to be able to tell (or be told) that it was time to shift location of care in order to take advantage of 'modern medicine' - it would only have been irresponsible if I'd insisted that I stay at the Birth Center when it was clear that intervention was indeed needed in this case.

Most people who feel their baby's life (or their own) was saved by modern medicine forget that 1) the medicine might have initiated the problem in the first place, and 2) those 'emergencies' usually take a good deal of time to be identified - that gives you loads of time in most cases to handle things, if someone is paying attention in the first place. Not that OBs aren't meaning to pay attention, but the discontinuity of care does affect one's capacity to grasp the subtle changes. Not to mention that 3) once identified, it takes some time to set up to resolve the issues in any setting, including the hospital, and 4) planning a home birth doesn't mean you would refuse to go to the hospital if you needed to.

Probably the biggest issue that you cannot be prepared properly for in a home birth setting is a serious, life-threatening birth defect. But you won't be prepared for that in a regular hospital, either. For example, my Dh's cousin had her 10th baby at home just a few months after Brendan was born (55 minute labor from start to finish, I think). He was born with a defective heart valve that prevented his blood from oxygenating (basically, the valve to his lungs didn't open properly, so while he got plenty of oxygen from the placental blood flow, he couldn't get oxygen from his lungs properly). He was medevac'd (helicopter) to a children's hospital shortly after birth. They couldn't help him there. They had to ship him to yet another hospital. Long story short, he is fine after having open heart surgery at all of 5 hours old, IIRC. If the valve had been fully closed, he'd have died, period. It would have mattered not at all where he was born (unless he'd been diagnosed prior to birth, and was born *at* the heart surgery unit, and even then, chances are good he'd have had serious brain damage - in-utero surgery would have been the only real option under those conditions, but that type of defect is hard to diagnose in utero, since the heart functions differently before birth). With the slight flow he had, if he'd been born at the usual local hospital, he'd have been in exactly the same condition - they couldn't figure out what was wrong, they couldn't treat him, he'd have to have been medevac'd anyway, same result. In that case, it is possible he might have been medevac'd a few minutes sooner (the chopper would have gone to the hospital instead of the parent's home), and that might in some cases make a difference. But the number of cases that would apply to is really, incredibly, vanishingly small.

Is the tiny risk of that kind of issue worth the trade off of reducing much higher risks in other areas, like infection or birth injury? That's something you have to decide for yourself. Some people would rather take the higher but well-known risks of hospital birth than risk feeling that it was their fault if some really unlikely but unknown and potentially untreatable risk arose in a home birth. I know people who opted not to birth at home just because they couldn't cope with the unknown micro-risks, and were more comfortable with the known risks, even though they knew the chances of the known risks were HIGHER. That's the same reasoning that some OBs use for induction and scheduled c-sections - there are known risks with those actions/interventions, but just letting labor go the way it wants to leaves too much range of possibilities for the unknown ... and it is the 'unknown' that generates fear, not the known (even if the 'known' is more significant a risk). "the devil you know" vs. the "maybe devil, maybe not-devil you don't"

Does that make sense? I hope that helps, rather than makes things worse. Overall, there really aren't that many complications to childbirth - we tend to think there must be loads of small ones we don't hear about, but there really aren't very many. Modern medicine is indeed a miracle for many women and babies, and lives are indeed saved every day. But having a home birth doesn't mean you are forbidden to use those life-saving techniques! Nor that you will be too late to use them if needed. It is just really easy to blame yourself or the location, because you cannot run the alternate experiment and see how THAT birth, THAT time, with THOSE conditions would have turned out elsewhere.

[JanB]

I like the point that Hedra made about most of these life-threatening issues not being time-critical. I also wanted to share a story that my mom told me.

After my C-section with Zeke, I called her and told her I'd had a C-section because Zeke was "transverse occipital" (i.e. trying to come out on the diagonal). She told me that my younger sister Amanda had also been malpositioned that exact same way. Furthermore, when Mom was laboring in the hospital, her OB was off having some kind of awards luncheon and couldn't be bothered to come check on her progress. The L&D nurses didn't have the authority to order a C-section, so Mom just continued laboring. She said that she only ever dilated to 9 cm, but she pushed Amanda out vaginally anyway -- this without the benefit of any drugs, mind you. She said it was absolutely the worst pain of her entire life, and in retrospect she wishes she'd had the C-section. Her recovery from that birth was extremely difficult and she says she still hurts in her perineal area to this day.

I wanted to point out a couple of things about this. One, had the OB been on hand to do the C-section, Mom would probably be one of those people saying that he had saved her life, even though actually it turned out not to be a life-threatening situation. Two, had she been under the care of a competent midwife in a homebirth setting (or even a competent care provider, period, in any setting) I firmly believe that they could have either managed to turn the baby properly, or got her into the OR for a C-section in time.

Due to my blood sugar issues and the state of medical malpractice lawsuits in this day and age, I am unable to have a homebirth (unless I did it unassisted, which I think is a very bad idea in my situation), but I honestly do think it's almost always a better option than a hospital birth. If you have a good care provider on hand, I really feel you have nothing to fear from a homebirth. If something does go wrong, as Hedra said, there's more than enough time to identify the problem and get you to a hospital.

[ubertulip]

I'm expecting my baby any day now, and I'm planning a homebirth. I had the "reasons to transfer" talk with my midwife this afternoon. Major bleeding in my case and continued respiratory distress in the baby's case were the only urgent reasons. I like the fact that I live just up the hill (literally 3 minutes) from a hospital, just in case one of those two things were to occur, but I'm not worried. I guess a critical birth defect is possible, too, but so very unlikely...

:)

[hunter]

Most people who feel their baby's life (or their own) was saved by modern medicine forget that 1) the medicine might have initiated the problem in the first place, and 2) those 'emergencies' usually take a good deal of time to be identified - that gives you loads of time in most cases to handle things, if someone is paying attention in the first place.

I was going to say exactly this! Whenever I hear the "would have died" thing, I just remember that those people have a different reality than I do. They made certain decisions, wise or not, and lived through the consequences, and I didn't. I likely won't be making the exact same decisions, so what happened to them is likely not going to happen to me.

Most people consider a breech or twins to be "emergencies ready to happen" but I don't. I believe that I labor best in the safety (emotional as well as physical) of my own home, I trust my body to do what's designed for, I trust my midwife & DH to watch for signs of trouble and advise me accordingly, and I proceeded with my planned homebirths for each of them. I was carefully monitored, probably better than I would have been at a hospital. Why should I go to the hospital if we're all making good progress? Yes, things could have gone wrong, and then I would have transferred; I'm literally minutes away from four hospitals. An emergency after birth? My midwife carries oxygen, a medication to stop bleeding that I can't remember, and other emergency supplies. She's trained in first aid and in infant resuscitation. We live in the middle of a City, so a 911 call would have the fire department & ambulance here in minutes, or again, we're just minutes away from four hospitals with emergency rooms.

Here's my "would have died" story. My sister Renee had an epidural as soon as she got to the hospital, she was 4cm. The nurse got her settled on her right side, the EFM was put on, she fell asleep, and slept for the next eight hours. I've joked that her labor was harder on me than on her, because I was awake the whole time! Renee rolled over in her sleep so she was on her back. After a while, the nurse came in, rolled Renee back over on her side, readjusted the monitor, and left. The nurse never once told us not to let her roll over; we found out later that she came in because the monitor showed the baby's heartbeat dropping. This continued about six times before they decided the baby was in distress. Renee was only at 6cm (despite Pitocin being administered halfway through the night) so the doctor suggested a c-section. As he was pulling the baby out, the doctor remarked that the cord was around his neck. My mom, my sister, and my BIL are all convinced that the baby, and probably Renee, would have died without that c-section.

However, what if she hadn't had the epidural, and had remained vertical for most of her labor? The baby's weight, and gravity, could have helped her dilate faster. What if she'd had a birth attendant who stayed in the room, or who communicated with those of us who were in the room, to make sure Renee stayed on her side? Perhaps the baby wouldn't have been repeatedly stressed from Renee rolling over so frequently. What if she'd at least just remained awake for a while? She probably would have been able to stay in a suitable position to keep the baby from being stressed, and to help her labor progress rather than stall for four hours before Pitocin, and then stall again for another four hours before anything else was done. As for the cord being wrapped around the baby's neck, that was discovered AFTER they'd cut her open. If her labor had progressed to enable a vaginal delivery, her attendant would have (or should, but I guess some don't from what I've heard) checked for the cord during birth. My midwife always checked for the cord, she said it can usually be unwrapped easily.

[miche]

My OB scared me into a c-section with that. After 13 hours of pitocin induced labor and only progressing 1 cm (in the first hour) I was told we better do it now before the baby or I went into distress. I was also told that it is a good thing that there are c-sections because who knows what would have happened if not for modern medicine.

My second labor progressed just as slowly as my first despite the fact that there was no pitocin involved. Sean was born with quite a bit of meconium inhalation and ingestion. Some have said it is a good thing I was at the hospital. I didn't have that much meconium staining during labor because it was mostly behind him. But a midwife could have suctioned him at home adequately and then we could have gone to the hospital pumped more thoroughly. As is they suctioned him by hand at my side for quite a while and then let me hold him for at least two full minutes before they took him to the nursery for further suctioning and chest xrays. He would have been fine on the short ride to the hospital.

[maureenb]

Don't know if anyone mentioned this - sorry if I'm repeating. I know that a prolapsed cord is another situation that requires a c-section.

I know I keep bringing up my one friend Lisa, but she truly would have died during a homebirth. Her uterus ruptured and she would have bled to death within minutes if she'd have not been at the hospital. When the rupture was complete, she said that the bucket below the table she was on filled up with blood. Very rare, I know, but scary. :(

[StephM]

I was glad when you posted this Aimee (as you can see by my first response :) ). So now I kind of have my own "would have died" story, except, like some of those here, it is a little different and would have more than likely had a better outcome at home.

A friend of a friend had her baby a while back ago. First baby, went a whopping 2 DAYS over her EDD, and was induced for non-medical reasons by a hip, young, totally in "the know" female OB (this according to her). As we see all too often, failure to progress beyond 2-3 cm, after a significant time, mild fetal distress due to pitocin and on the back position of mother. C-section done.

Fast forward to 7 weeks later. Mom desperatly needs a MRI to screen for a disease, but is unable to have it until now because of the C-section. She has now finally had it and will be having surgery this week. Had her Dr. not induced for non-med reasons, there is virtually no reason she could not have had this baby vaginally. She had a difficult recovery from the section, and is just now feeling ok. And she will now be undergoing more surgery (non-related to section), but yet one more to recover from and make picking up that sweet new baby even more difficult. And she had to wait a potentially dangerous amount of time before having the MRI, due to the c-section.

Maureen, if I remember correctly, your friend Lisa had a prior c-section and was attempting VBAC? Prior c-section does make for a small added risk of rupture to second labors, but if it is not induced, can be virtually just as safe as a non-VBAC. You did not mention if Lisa was induced with her second labor or not. These details would be helpful in answering questions such as the ones posted.

I also know of women suffering rupture's, as well as abruptions, in the hospital that had poor outcomes (maternal/fetal death). Being in a hospital does not gurantee safety. I think about it like this sometimes: A rupture, placental abruption or cord prolapse can happen in early labor and even before labor begins. Do we hospitalize all women for the entire 9 months of pregnancy, just in case? What about early labor? Why does even the hospital itself tell us to stay home until in strong, active labor?

[born2birth]

A lot of people say that because that's what they were told. It's incredibly cruel the things a doctor or midwife will say to an expectant mom just to get her to do what they want.

I had a homebirth with some complications. I had a prolonged pushing stage (5 hours) and then shoulder dystocia. My midwife handled it very well and all was fine. He was a little slow to start breathing on his own, but she was well prepared and everything turned out just fine.

[hedra]

Just wanted to note, for those who didn't slog through my whole earlier post ;) , that prolapsed cord is not always (though often) best resolved by c-sectioning - the standards of care specify that the decision to c-section depend largely on the degree of dilation acheived, among other factors (like, if you have had other kids, AND have dilated substantially before the prolapse was discovered, chances are better that pushing will be the best plan, because the pushing stage is often short in multipara moms). Many times, pushing or even forceps assistance is way faster than a c-section, if they have to get the equipment together, etc. The risks are high either way, and each has to be decided on a case-by-case basis.

[maureenb]

Sorry, Steph, I should have mentioned - no, Lisa wasn't induced...she was really adament about avoiding that because, with her previous C, she knew of the uterine rupture risk. In fact, she almost didn't go to the hospital when she did, as she was sure she wasn't in "real" labour. We're just grateful her dh said, "Let's go anyway." Like I said, I know that what happened to her is a rare instance, but it really, really makes you think when something like that happens to someone close to you.

Hedra - didn't realize you could still, in some instances, still have a vaginal birth with a prolapsed cord. Every book I've read made it sound like that wasn't even an option. You learn something new every day! :)

[hedra]

You won't see it much in info for the patient/client. You WILL see it in info for OBs on standards of care lists. Probably because your risk of getting sued for deciding to push is astronomical. Your risk of getting sued for c-sectioning even if it wasn't the optimal choice is much smaller - people tend to assume that the more extreme the attempt to deliver, the more seriously they took the problem. Heroic measures, though, aren't always the best approach, they just look heroic.

Also, it is important to note that it is also fairly rare for a prolapsed cord to be discovered or occur 'late' in labor in most OB settings, because that usually means that the bag of waters hasn't ruptured (that cushions the cord if it is ahead of the head - once it is ruptured, though, the pressure is ON). Once the cushion is gone, you have elevated the issue to a c-section-now situation in most cases. Still not all cases, but most. So, given the rate of AROM/amniotomy in OB settings, your chances of having vaginal birth as the best option available are mighty slim.

I know of one woman whose cord prolapsed 'officially' at transition, when the waters broke on their own (the baby's heart tones had been fine through the whole 10 cm, even with the cord ahead of itself). She felt the cord slip out with the waters, the midwife told her that given where she was in labor (stage of labor) and given her history with pushing (good pusher), and the baby's position (optimal), pushing really hard and fast was her baby's best bet for survival. She had the baby in less than three minutes (with substantial pushing coaching) because it was really too late to section and it would have taken a lot longer if they'd tried it that way. The backup OB wasn't even there by the time the baby was born. (she was fine, too) (Still a really risky situation, but in that case, for example, vaginal birth was the best plan.)

[Whit]

Originally posted by hedra
Just wanted to note, for those who didn't slog through my whole earlier post ;) , that prolapsed cord is not always (though often) best resolved by c-sectioning - the standards of care specify that the decision to c-section depend largely on the degree of dilation acheived, among other factors (like, if you have had other kids, AND have dilated substantially before the prolapse was discovered, chances are better that pushing will be the best plan, because the pushing stage is often short in multipara moms). Many times, pushing or even forceps assistance is way faster than a c-section, if they have to get the equipment together, etc. The risks are high either way, and each has to be decided on a case-by-case basis.

Thanks so much for this info, hedra. I've been reseraching prolapsed cords for a couple of days and this is exactly the kind of information I was looking for. With my first, I pushed for 25 minutes, and my second only took about 5 minutes. So it sounds as though pushing would be the best bet in my case...

In my research I learned that prolapsed cord is much less risky if the water doesn't break until immediately before or during the pushing phase... Oh, and it takes at least 30 minutes for the docs and hospital to get ready for an emergency c/s.

[hedra]

Sorry about the cord prolapse hijacking, here...

Just wanted to note that even with a good pushing history, there will still be cases where c-section IS the right choice, such as if the water breaks earlier in labor and you aren't dilated enough yet, or baby is posterior and pushing is likely to be long... And also, in some hospitals, time to c-section is as low as 5 or 6 minutes, using general anesthesia or an existing epidural catheter (it is in the hospital I had for Brendan - they have staff and surgery rooms set up 24/7 because they are a high-risk specialist center).

Oh, and I've learned a lot about cord prolapse issues because I had polyhydramnios with Brendan, which increases the risk of prolapse significantly. Even after my water broke, his head would bounce right off my cervix (high leak, with the amniotic sack intact under his head - ideal leak for PH, but it didn't leak ENOUGH, darn it all, and I still got risked out of the birth center and sent to the hospital). Also more risk of abruption with PH. And, as I discovered, it is possible to not be diagnosed with PH 'early enough' to switch care smoothly - I was diagnosed on my due date, which was the day I went into labor and had Brendan!

I just had to get that caveat in, regarding safety each case also includes specifics about the labor, as well as the mom's birth history. :)

[babsalaba]

Well, speaking as one woman who really would have died if it weren't for my OB, I can tell you that a severe placental abruption is a life-threatening event for both mother and child. (Please read my story before you start rolling your eyes...)

In my case, I firmly believe that if the nurses had been taking my concerns seriously, my son would not have died. It was only my OB who listened to my fears (and the fears of my SIL who was with me) about the amount of bleeding I had. It was she who correctly diagnosed my abruption. (which, btw was a 100% abruption) I was immediately wheeled to an OR and had a crash C-section. She told me that as soon as she made the uterine incision, the placenta popped out, covered with huge blood clots (sorry if it's TMI), more proof that it was a 100% abruption. In case anyone thinks that perhaps she cut it during the incision, the placental pathology report indicated otherwise.

The reason I say that the nurses weren't taking my fears seriously is that although I told them repeatedly that I was really bleeding, they said, "Oh, well, you're just dilating fast. It happens." My SIL even told them that I had drenched napkins with blood, but she had left them in the car in order to get me up to the ward. The nurses countered with, "Oh, when there's blood in the amniotic fluuid, it can look like a lot of bleeding." Never mind the fact that this was bright red blood. The fact that I was in a lot of pain merited nothing more than remarks like, "Well, labor is painful y'know."

They didn't start to relaize that anything might be wrong until they relaized that the pulse of 120 bpm which they were reading on the fetal monitor was actually mine. If they had taken mine earlier, perhaps they would have called in my doctor sooner, never mind the fact that I repeatedly asked to see an OB, any OB, even the one who was at that time idly sitting in the lounge, just two doors down!

Now, although I would never again deliver anyplace but a hospital, this is not a glowing report of hospital care- I agree. The nurses were just awful about listening to me, preferring instead to go about their preordained "routine" instead. I'm sure that they will not forget it, the looks on their faces when they realized that "YES, the laboring woman WAS correct, there was something dreadfully WRONG, and we missed it!" was proof of that. I'm sure that they won't forget what happened. The hospital was small enough that they didn't deliver stillborn babies all that often.

I could never consider a homebirth for myself because I would worry that with my history, it might happen again. When my daughter Lucy was born just three months ago, you'd better believe that I told the nurses what had happened before. While in labor, I was pestering them with questions- what was MY hb vs. the baby's? was I bleeding? etc. I don't give a rat's behind if they took offense at my constant stream of ?s, I knew for a fact that sometimes the worst happens, and I wanted to make sure that it didn't happen again.

That said, I admire you and all th others who strive for a homebirth. If only more doctors and nurses really listened to the laboring woman with respect and coonsideration instead of with the attitude that this is just some dizzy, hysterical pain-drunk broad, I think that even hospital births could be a pleasanter, less-intrusive ordeal.

Good luck!

[Amieee]

babsalaba,
I am so sorry for your loss. I know that must have been devastating.
I am so greatful for the hands on monitering that my homebirth midwife will do. We have already discussed how I can be totally sure that any bleeding on my part would send me straight to the hospital.
I am glad you survived and am very sorry for the loss of your son.


I really appreciate the comments about time criticalness. (and thank you, hedra, for all the info and for all of you that have shared your stories, firsthand or otherwise) I think that was kind of what I was alluding to in my OP, moreso than if surgury was necessary, and if an OB was necessary, but the "Oh, if I hadn't been right there in the hospital already then I or my baby would have died!" I truly believe in my heart that there is ample warning for things provided the quality of care is there.
I would make sure I had an OB that I trusted and all that, but we all know it is the nurses who really run the show and that most OB's just pop in every so often. I don't think I would feel any safer under their care.

The prolapsed cord thing does scare me a bit, but the way I see it is that if that happened, I would most likely nt be at the hospital even if I were planning a hospital birth. IMO, I am better off planning to have the whole birth at home than I am to plan a hospital birth and waiting until I am very far along in labor like is being encouraged in my childbirth classes.

[kiwichick]

I haven't read all the great answers to this thread so far, but just had to add my first thoughts....

I hear the "babies cord was round his neck" statement all the time as a reason why a c-section etc was the reason for an emergency c-section........and sure, there are times when this is true - I know of a women who have had a c-section as the baby would not descend b/c the cord was so tightly wrapped around the child.

Cords round necks are pretty common though, and it's pretty normal for them to be looped around the neck....a good midwife will suspect this and will check for this when your babies head emerges.....no real drama there.......both my kids had their cords wrapped around their necks........although my midwife did say she thought that DD's was stylishly draped around her neck!! LOL

Oh, and the meconium one is another I have experience of as I was transefered from the local birth centre into the main hospital to deliver DD due to meconium staining in the liquor. This is on our public health system so I didn't have any choice.......again though the whole thing was dealt with by my midwife and no doctors came near me .......oh yeah, except to suture me :o

My Midwife commented that the compulsory transfer was really silly because had my waters not broken before labour started, no-one would've been any the wiser about the meconium staining until my labour was advanced, and they would not have transfered me at that point......

I guess that's an example of how "routine procedures" can be really dumb sometimes!

[kiwichick]

Babsalaba, I've just read your reply and I am really sorry for your loss, I have read your story before...........:(



I am constantly amazed by the poor standard of care that many women recieve and I truly believe that all women should have midwifery care - and should have a lead carer who is with them for their entire labour.

This is what I have been fortunate enough to have, and it truly makes a huge difference having a female professional at your side for the whole 6, 9, 12, 24 or more!! hours of your labour.

Having professionals around you who don't take you seriously, or who don't know you, or who change every 8 hours, or who aren't watching you and observing how you are labouring must dramatically increase the risk of disasterous experiences.

[miche]

kiwichick brings up a good point! The two things she mentiones, cord around neck and mec were both present with my vbac baby. I know that cords around the neck are very common and usually they can be slipped right over the head. In Sean's case it was too tight. My OB tried to slip it over several times, but it wouldn't go so she clamped and cut it and told me to get him out with the next push! There are cases where a cord is wrapped so much around the baby that the baby doesn't descend, but that is rare. A simple loop around the neck is very common and in a hospital or home environment OB's and midwives are trained in how to deal with this. Even midwives at home have the supplies to clamp and cut a cord if that is what is needed.

[woggly]

I am pretty sure that medical attention at the hospital saved my son's life and possibly mine, but I also think that if I had tried for a home birth there would have been enough time to transfer me to a hospital. I also think that if my doctor had been more attentive during my regular prenatal checkups, some of the problems I had would have been discovered weeks earlier - such as the fact that my son basically stopped growing at 32 weeks or so (he was born 4lb 6oz at 39 weeks) - and I should not have been a candidate for home birth to begin with.

Even when I arrived in the hospital in labor, no one realised how small the baby was, which as far as I'm concerned was the #1 complication. But there were other "bad signs" that propelled me to emergency status: very high blood pressure that did not go down with medication, high levels of protein in my urine, baby's hearbeat was dropping, amniotic fluid was heavily stained with meconium (we're talking sludge...) It later turned out the cord was wrapped around his neck too, but that was the least of our problems I think.

Anyway, I do think hospital care saved our lives, but I don't think this reflects on how we would have done in a responsibly tended home birth.

[Sassy Mama]

I have not had any babies at home and I probably will not in the future, but that does not mean it isn't right for someone else. My first baby was born via emergency c-section due to a prolapsed chord (a rarety), the time it took for them to get me to the ER from my room and get the baby out was 7 minutes! However I do not know a single other person who has had a prolapsed chord and if you have a reputable midwife she would be able to get you to the hospital in time to take care of it! Most midwives work with an OB so that if they need a c-section performed it can be done! She will know of all the signs to look for for fetal distress and any complications that could take place! I guarantee you that yours and your baby's safety are her first concern and she will do all she can to prevent any problems. I would trust your instincts and do what you feel is best for you. My Mother was just the opposite of yours, she thought I should have my babies at home and avoid the hospital all together (she had two babies on her bedroom floor). If you feel confident and want to at least try I bet you could do it with no problems! I hope it works out and you get the birth you want!!