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In class one topic we discuss in length is options
for care including hospital and out-of-hospital care providers.
Ultimately each individual needs to choose which birthing
environment she feels most comfortable in, but it’s
my job as a childbirth educator to help women and their partners
understand the pros and cons of each option. One thing we
stress is that out-of-hospital births are safe for low-risk
women (and even women with some risk factors as determined
by the woman and her care provider) and that the hospital
is there if she needs it. I encourage couples to interview
out-of-hospital care providers and ask all their “what
if” questions and I remind them that out-of-hospital
care providers are trained to watch for a potential problem
and transfer a client when necessary. Naturally one concern
that often comes up is what happens when transfers DO become
necessary. I often hear things such as, “I’d like
to birth at a birthing center but I’m worried what it
might be like if I had to transfer.”
Obviously if someone planned an out-of-hospital
birth they don’t want to end up needing to transfer
to a hospital, but it led me to think, how do people feel
about their choices after a transfer happens? I have had 17
students who originally planned an out-of-hospital birth and
either transferred to a hospital before or during labor or
mom and/or baby transferred after labor. I asked these 17
women and their partners to answer the following question
about their choice of birth location:
Looking back,
do you think it would have been better if you had just planned
to birth in a hospital? Why or why not?
Of the 17 women I surveyed, I had 5 women and
1 partner respond. All of them said they were glad they planned
an out-of-hospital birth even though there was a transfer
and some of their responses are below. The point of this article
is not to say that every woman who plans an out-of-hospital
birth and experience a transfer is glad that she planned an
out-of-hospital birth. This is obviously a small sample size,
but it may be fair to say that many women who plan an out-of-hospital
birth and experience a transfer are still happy with the choices
they made. Responses may also vary region to region and most
of the responses in this survey are reflective of the Tampa
Bay area.
Sonja planned to birth
at birth center but had to transfer to an OB’s care
after she went past 42 weeks gestation. Her OB tried to induce
labor but ultimately Sonja ended up with a cesarean section.
Sonja said:
I stand by my decision
to plan an out of hospital birth, even though we ended up
transferring to hospital delivery. Although we ended up
with an emergency C-section due to the lie of the baby,
the techniques and information that we learned in our natural
birth preparation helped navigate the early stages of labor
and gave us the knowledge we needed to make informed decisions
about the hospital care and newborn procedures that we felt
comfortable with and those we wished to decline. If we had
decided to go to a hospital the whole time, there would
have been much more mystery about the physical process of
the birth, and I would most likely have gone with pain medication
as the assumption in the hospital is not whether you will
take pain management, but instead when they should start
the epidural. I feel that natural childbirth preparation
helped in the sense that I was able to labor for 8 hours
with my son sans medication, and could recognize the difference
between "good" or effective pain, and when things
began to tip toward "bad" pain. Without the training
and extensive library of birth facts and research I received
through the preparation for out of hospital birth, I feel
that I would have always wondered whether the C-section
was absolutely necessary or if it was just a medical convenience
for the staff of the hospital. However, since I did have
extensive preparation I am convinced that the outcome was
medically necessary for the health of both mother and child.
Also, since my first C-section, I have had a daughter through
successful VBAC. Due to being classified as high-risk, this
second birth was planned as a hospital birth, but again
I feel that the knowledge and techniques drilled into my
head from the natural birthing classes prepared me to be
successful in having a non-medicated VBAC delivery. Through
another complicated series of events, I ended up having
to deliver at a hospital that I was not a registered patient
at, and found myself again relying on the training that
I received beforehand. I feel that preparing for an out
of hospital birth gives one the flexibility to effectively
deal with unexpected situations. When you plan to deliver
at a specific hospital it is easy to fixate on the procedures
and familiarity of that unique place. If plans unexpectedly
alter it can be jarring and demoralizing, there are new
procedures, new personnel and such, the whole game plan
has to change at the last minute. Out of hospital birth
planning forces one to expect the unexpected, and I strongly
feel that the natural birth planning directly led to my
successful VBAC experience.
Tiffany had a homebirth but transferred to a
hospital postpartum due to a retained placenta. Tiffany said:
I feel very strongly that planning a homebirth
was the right choice for my family. We had the birth we
wanted, period. Our daughter was born into a clean, safe,
warm, loving environment and we were in control of everything.
As I laid on my bedroom floor holding my brand new baby
girl with my husband at my side, my closest family and friends
in the room, and my sister and 4 year old niece (in West
Virginia)via Skype I felt like I was on top of the world.
Nothing can beat that moment for me. It was a few minutes
later that we discovered my placenta was being stubborn.
I was very calm through this part for some reason. I was
satisfied. I got what I wanted, my baby at home. In that
moment there was nothing that could bring me down. Meanwhile
the ambulance was on its way to pick me up and transfer
me to the hospital of my choice for a D&C. I felt fine
but I had been losing quite a bit of blood. We had no idea
what to expect at the hospital but we felt strong and safe.
After I had a week or so to process the events that transpired
I felt so pleased with everything. I feel like by having
my successful birth at home and then a successful transfer
and a positive recovery, we are proof that homebirth is
safe! When a medically necessary intervention came about
we were able to get to a facility for help. If anything
this made me feel even more sure that I will birth at home
for all of my children. People hesitate to make birth plans
but I can honestly say that ours was followed perfectly
and I believe it was because of the communication between
us and the midwife. Our birth plan and our emergency backup
plan had been hanging on our bedroom wall for at least 2
month before our birth. I never considered planning a hospital
birth and I do not believe that my outcome would be been
any different if I had birthed in the hospital.
Mary planned a homebirth
but went into labor at 36 weeks and was transferred to an
OB’s care. Mary said:
I do not think it would
have been better to just plan the birth in the hospital
AND we are planning the next baby for home birth. I feel
that making the choice to birth at home guided me to educate
myself more on the topic of birth more than if I had just
planned a hospital birth. With the information I learned
I was able to manage my birth better even though it did
end in the hospital. I didn't allow the hospital staff to
treat me as a cookie cutter case because I was armed with
knowledge to make my own choices.
Amanda planned to birth at a birth center and
transferred to a hospital during her labor because she was
having difficulty with the labor. Amanda said,
I think that had I planned a hospital birth,
I would have had a horrible experience...probably epidural,
pitocin, etc., but just no control. But, the difference
would have been that I would not have gotten a taste of
what birth could be. So I'm definitely glad I didn't plan
a hospital birth.
At her first birth, Amanda felt that she didn’t
get the care and support she needed at her birth center. (This
particular birth center was not in the Tampa area.) She felt
that her midwives weren’t as encouraging and as supportive
as she would have liked and that they transferred her because
they didn’t know what else to do to help her. After
her transfer she received an epidural and immediately after
her baby was vacuumed. The epidural didn’t have a chance
to take effect until stitching. Amanda feels in her case,
it wasn’t so much an issue with location but rather
care provider. You can have a good (or a not so good) care
provider in any location but the important thing is to find
someone who is on the same page as you that you can really
trust. Amanda goes on to say:
I do wish I had prepared myself better and
not relied on the Midwives at all. I think if someone wants
a specific birth, it all comes down to educating and preparing
yourself, not necessarily location.
After her birth experience Amanda went on to
have a homebirth and was very happy with her care provider
and the experience.
Mark and his wife planned
to birth at a birth center. During their long labor they chose
to transfer to a hospital. Mark shares their journey and thoughts
after the fact:
The birth of our first
child was a unique time of family bonding, exceptional emotional
sharing, lifetime transitioning and exploration. It was
planned, researched, trained for and yet unknown. Neither
my wife nor I knew exactly what to expect, but throughout
the pregnancy we demanded to be informed, practiced and
aimed to do everything in our power to make this experience
as positive and special as possible. And we did.
We started the pregnancy
with an OB group in-hospital but after a few short months
we jointly made the decision to explore opportunities for
an out-of-hospital birth. We interviewed a number of midwives
and birthing centers and we found the perfect fit. We took
Bradley classes and did a lot of reading from a myriad of
sources. We took in-hospital classes, and filed in line
for hospital tours. I even completed a ‘Daddy Boot
Camp’ which I would highly recommend for partners
if you find a good fit for you. We wanted this experience
to be informed. In fact, we were shocked how mainstream
ignorance of the process could be for many parents-to-be.
Despite this fact, we
were confident the situation we chose was best for us as
a family. So we planned accordingly, and before we knew
it, my wife was starting labor. We knew what we might expect,
how situations could be handled, and we were relaxed and
stayed relatively comfortable. We walked. We ate. We tried
to nap. But mostly, we stayed together, and we weren’t
worried. The day grew long, and after a shower and a few
calls to our midwife, we decided to head to the birth center.
Upon arrival we spent
time with our midwife, took short walks, spent time in and
out of the tub, shower, ball and bed. Several hours passed,
and labor intensified. We had learned ways that I as the
partner could help my wife relax using massage, positioning,
and simple togetherness. I was calm, and this helped my
wife.
Several more hours passed
and progression was limited at best. Ultimately, our midwife
and her team had a conversation with us. Things were safe,
but not moving forward. My wife had been laboring for over
a full day. They suggested we transfer to hospital. Honestly,
I thought it was the wrong decision, but my wife was willing
to try anything at this point, and my job was to support
her. We loaded into two cars, my wife and me in one and
our midwife in a second. They called our local hospital
and they were expecting us.
The drive was no more
than 3 miles. The clouds opened up and a monsoon was pouring
from the sky. Despite the short trip and the distractions
or the road and rain, my concerns lay on my wife, her health,
our baby and how we would be received at the hospital. I
was worried on all counts. I felt I lost the control and
comfort the birthing center provided us. But things moved
quickly, and I needed to be on my A-game.
Luckily, I had little
to worry about. Our midwife had told us she had a great
relationship with the OBs, and she did. The staff was very
supportive, never negative, and helpful in every way possible.
We were in a room in seconds, and the doctor saw us in minutes.
A group of staff picked my wife up and repositioned her.
She was too uncomfortable to do so on her own or with my
meager help. That was the trick. The birth was soon to follow.
Our doctor kept things
light. Our midwife held my wife’s left hand while
I held her right. In little less than an hour our daughter
was born. Naturally.
The baby had been subject
to a monitor as soon as we arrived, and she was not under
stress. However, at birth she aspirated meconium and needed
immediate medical intervention. I stayed with our child
as she was transferred to the NICU. Our midwife stayed with
my wife. In some time I had spoken to our daughter’s
physician, and returned to my wife. She was worried, relieved,
exhausted and overwhelmed. Thank goodness our midwife was
there to support us.
Our daughter remained
in the NICU for well over a week. The infection cleared
and she began breathing on her own after some time. The
recovery seemed quick but the hospital was cautious. This
grew frustrating, but ultimately was for the best.
I learned many things
from this experience. First and foremost: expect the unexpected
and roll with the punches. This said I would not have changed
the experience in any way. I would not have opted for a
hospital birth. We were able to handle adversity because
we were coached and comfortable. Our midwife and birthing
center gave us the confidence and support we needed to endure
a long arduous labor, and facilitate a positive hospital
transfer.
It is impossible to
say how things would have gone had planned an in-hospital
birth. What can be stated however is that we were informed
and therefore relaxed, which allowed us to weather the challenges
we ultimately faced. I, as the coach and partner, found
this invaluable and therefore from my perspective our out-of
–hospital birth was a wild success. This comes despite
the necessary transfer. After all, that is why transfers
are always an option when needed.
Again, choose whatever birth location
is right for you. Find a care provider you trust and who treats
you with respect. It’s important to understand each
option as best as possible. If you plan an out-of-hospital
birth, it’s a good idea to tour your back-up hospital.
Transfers are not likely but when they do occur, it can go
a lot more smoothly and be less scary when it’s not
to an unfamiliar place. I tell my students who are concerned
about the possibility of transferring that not all transfers
mean that you have no options, but if you don’t know
your options than you don’t have any. Know your preferences
and how to make decisions if needed.
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