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13th November 2011 01:43 PM #1
Ways to facilitate a postive experience if a hospital transfer is required
At the Pregnancy and Parenting Network in October we discussed Unexpected outcomes at length. One of the main topics for discussion surrounded how to facilitate a positive experience if a hospital transfer is required. Sometimes a transfer from a homebirth into hospital is well received - however mostly they are not. The group really wanted to look at positive strategies. The strategies discussed included:
- Choosing supportive people to take with you
- Preparing partners carefully - so that you are both on the same page
- Writing a birth plan
- Be positive but firm with the hospital staff when making your needs known
- When making non urgent decisions - ask the hospital staff to give you 10 minutes to work out the best decision for you
- Logically review any interventions recommended using the mnemonic BRAND
- Benefits of the intervention
- Risks in the intervention
- Alternatives to the prospective intervention
- Nothing: what happens if you do nothing
- Decision - what is your decision?
- If declining a proposed intervention or management strategy choose your language carefully i.e. "Thank you, I respect your recommendation/policy however I have decided ..."
- Make the hospital birth space your own i.e. cover the clock, remove the bed from the centre of the room, using bean bags, mats, music, essential oils (you'll need an electric burner for this), take some extra pillows from home etc.
- Have partner, private midwife advocate for you
- Discuss private midwife's roll in the event of a hospital transfer
- Write a thank you letter after the birth to the hospital
Is there anything you'd add to this list? What was your experience of a transfer into hospital after a planned homebirth?
9th January 2012 03:31 PM #2
My sister-in-law had a hospital birth with her first baby and planned for a homebirth with her second. She laboured at home for many hours but during transition baby would not descend, so the midwife decided to transfer.
My sister-in-law took a great big step up into the truck and that's all it took for baby to change position and start moving down quickly.
They were only 5 minutes from the hospital and she ended up delivering just 3 minutes after arriving. She was discharged within the hour and went home with baby in arms.
Had she tried big, lunging steps at home, she probably would not have had to have been transferred, but they obviously didn't know this. From what she told me, there was no problem at all with the hospital staff and everything went very smoothing.
My sister-in-law has raised her two grown children and is now in school to get her nursing degree in an effort to become a licensed midwife.
This is the only experience I've personally been aware of where mum was transferred, but I do know that my first midwife required that I be within 10 minutes of a hospital in case a transfer was needed.
10th January 2012 08:30 AM #3
Thanks for sharing Kate. A great website for trying different positions in labour to help the baby descend is spinning babies - I have used their website when supporting women in labour when we've needed additional resources. I always try everything before recommending a transfer to hospital.
The distance away from a hospital when planning a homebirth is an interesting one. Most literature says women should live within 30 minutes of a hospital - however when I went looking for the research evidence behind this recommendation - I found there was none. Many homebirth programs exclude women when they are outside this boundary. It troubles me when arbitrary limitations are placed without good research evidence. I must say I haven't heard of needing to be within 10 minutes. I'd say that was a limitation based on the midwife's comfort level.
11th January 2012 02:56 AM #4
Distance "comfort zone"
I'd tend to agree that the limitation of being within 10 minutes of a hospital was the midwife's personal comfort level. My second midwife didn't have a "within so many miles of a hospital" limitation. However, my second midwife delivered a baby that was 45 minutes away from a hospital, and it was a scary situation. My best friend's daughter, Meghan, was with this midwife and was an apprentice. It was one of her first births to attend so she didn't have much experience yet. But it was just the midwife and her apprentice, and the baby had difficulties breathing. It was a fairly big "45 minute scare" to the hospital. Baby survived and was fine, but the midwife decided to reassess her personal comfort zone after that.
I'd suggest that every mum discuss her comfort level with the midwife. This way they would both know each other's comfort zone and may even be able to compromise a bit depending upon circumstances.