Contingency plans for home birth

[sonitaw]

Ok some backstory, DD was a home birth, she was born in 3.5 hours after my water broke, strong and healthy, we had nothing but a positive experience. There was meconium in the waters but I didn't know that this is considered high risk because early on in my pregnancy I stopped googling things (I have PCOS and the high MC statistics worried me to death, I just stopped). My midwife monitored her and there were no problems.

With this baby I have been pretty laid back not reading too much because I have done it before. My best friend just got pregnant with her first and is trying to decide between a home birth and a hospital birth with a midwife. She of course was telling me all the "what if" scenarios that she read (some of them on anti-HB sites) could happen, and now I am all paranoid.

Looking back with DD I didn't research any worst case scenarios, I just went into it clueless (more like I trusted my midwife to tell me if I needed to go to the hospital). What have your experiences been? Did you have a list of what-ifs that if any of them occurred you wanted to go to the hospital? Today I started to read the reasons for transferring and stopped when I saw the meconium on there, it really wasn't that big of a deal for us, but if I had known that beforehand I might have freaked out and had a totally different experience. I am going with a CNM this time who has 30 years of experience birthing in and out of the hospital, she knows her **** and I trust her, I am just wondering if there is any more self education I should be doing. I am torn because there is a fine line between being educated and giving yourself too many things to worry about. Just curious what other people's experiences have been.

[tibeca]

Talk to your midwife. Find out what she considers a concern and reason to transfer. Small amounts of meconium are not necessarily a reason to panic. My daughter passed meconium right as she was being born... Once her body popped out, she pooped into the water. Since she didn't breath until she was brought to the surface, no concern of aspiration.

Talk to your midwife. Let her know what you're worried about. My midwife knew that I felt if anything looked even a little bit suspicious, I wanted to go to the hospital.

[pkaskaggs]

yes...talk to your midwife. with my 1st pregnancy, it seemed like i came to every appt w/ something i was worried about that could go wrong. one-by-one she talked about my concerns and how she would handle the situations. i always left feeling so much better about my choices.

[sonitaw]

I was talking to my husband about it last night and he said we talked to our midwife about when a transfer would be necessary, apparently I have just completely forgotten enverything we did last time!!!

I am guessing the new midwife will have that talk with us as well :-)

[Arisce]

I've done a lot of research. If my water broke and there was THICK mec in it I'd... probably stay home since I had a fast labor last time and likely wouldn't make it to a hospital before the baby came anyway(hospital is 1.5 hours away by car, although I think we could make it in an hour but if we had to wait for an ambulance...). We would most likely transfer after. Excessive bleeding, excessive pain(this is subjective I know, but having gone through a complication free OOHB before I think I can tell the difference between regular labor pain and something that wasn't good) or me just feeling "off" would be grounds for me to discuss transfer with my midwife.

I wouldn't transfer for a breech presentation. I would transfer if we had an arm presentation and no head and it was decided that the baby was transverse(cause no baby is going to be able to come out that way). And as long as I'm past 35 weeks I'd have the baby at home and transfer after if need be. I realize that that's still a late term preemie, but my sister was born at 35 and a half weeks and did great(went home 8 hours after she was born). I realize everyone's comfort level is different on that though.

Most of the things I would transfer care to a hospital for would be found well in advance(previa, accreta, pre-e). And if a problem did arise after birth in either myself or the baby we would transfer.

I personally couldn't blindly trust any care provider. I need to know possible outcomes to make an informed decision in my care and my child's care.

[Arisce]

I've done a lot of research. If my water broke and there was THICK mec in it I'd... probably stay home since I had a fast labor last time and likely wouldn't make it to a hospital before the baby came anyway(hospital is 1.5 hours away by car, although I think we could make it in an hour but if we had to wait for an ambulance...). We would most likely transfer after. Excessive bleeding, excessive pain(this is subjective I know, but having gone through a complication free OOHB before I think I can tell the difference between regular labor pain and something that wasn't good) or me just feeling "off" would be grounds for me to discuss transfer with my midwife.

I wouldn't transfer for a breech presentation. I would transfer if we had an arm presentation and no head and it was decided that the baby was transverse(cause no baby is going to be able to come out that way). And as long as I'm past 35 weeks I'd have the baby at home and transfer after if need be. I realize that that's still a late term preemie, but my sister was born at 35 and a half weeks and did great(went home 8 hours after she was born). I realize everyone's comfort level is different on that though.

Most of the things I would transfer care to a hospital for would be found well in advance(previa, accreta, pre-e). And if a problem did arise after birth in either myself or the baby we would transfer.

I personally couldn't blindly trust any care provider. I need to know possible outcomes to make an informed decision in my care and my child's care.

[1healthylady]

I am planning a home birth, but if at any point the MW doesn't feel comfortable delivering my baby at home, we will transfer. And depending on the reason for the transfer depends on which hospital we will go to. If it is a true emergency, we go to the one 4 minutes away from my house, if it's just because I'm tired or some other non-emergency, we go to the one across town (10-25mins depending on time of day) where she has privileges. I had just read the other day that meconium should put the caregiver on alert status, but not emergency status. They just need to be aware that it could be a sign of fetal distress. Depends on what other symptoms there are, but everything could be perfectly fine.
Like PPs have said, talk to your midwife. We switched from a hospital MW to a home birth MW at 21 weeks and went in for our one hour consultation with almost 2 pages of questions. I had already done a lot of research because hospital births scare me (too many friends' births have traumatized me lately), but I wanted to hear her answers, and I needed DH to be on board so I bombarded her with my (and his) questions, both the simple and complex. She exceeded my expectations. After that visit I felt totally comfortable and have complete faith that she will do what is right and will never put me and my baby in harm's way just to get a home birth. My MW will likely not deliver a breech baby at home for a first timer. She would for subsequent pregnancies, but not for the first one. If that is what she is comfortable with, then that's fine with me. Remember you are educating yourself. You likely won't run into any of the problems you're reading about. But if you do, you can arm yourself with the information to make an informed decision.
I think the most beneficial researching was reading Ina May's Guide to Childbirth. Through the birth stories, I learned things like how a c-section could be avoided for shoulder dystocia. Then part 2 talked about the physiology and psychology of natural childbirth and that kinda wrapped it all together. I would stay away from reading too many horror stories online, although I do really enjoy the Birth Without Fear blog. Other good books that aren't so information overload are Baby Catcher by Peggy Vincent, and I'm almost done with A Midwife's Story by Penny Armstrong. Those have been good for me to give me the perspective of the MW and what they see.
Good luck with everything, and remember to ask questions! That's one thing I love about MW care is that our visits are an hour instead of the typical 5 minutes you would get with a doctor.

[momomom]

My former midwife was really good at screening out potential high-risk clients and her transfer rate was veeeery low. I knew I could trust her and my body. I also had a back-up physician for both of my HB's and they were both great.

We will probably have this baby at a free-standing BC only b/c HB is more or less illegal in NE. Grrr. But the mw- whom we haven't yet met irl, is great!