What if We Need to go to the Hospital?
I am particularly passionate about the topic of home-to-hospital transport. Nobody wants to be hospitalized, but the presence of the hospital and the willingness of hospital care providers to show up for the home birth community is essential to the safety of home birth. Home-to-hospital transports are not that rare. This is because we aim to transport for risk factors that arise, long before an emergency arises.
When we transport to the hospital, it is important that I am present with you, as I need to provide your records and give a report to your new care provider. At that point, I step into more of a labor doula role in this new environment. You and your baby can return to midwifery care when you are stable and discharged from the hospital.
While my licensing does not require me to have a “back-up OB” (that term is a thing of the past), I do have relationships with several area OBs and hospitals. We will make a plan in prenatal care about what your best transport hospital is, and I will encourage you to pre-register there and take a hospital tour.
The most common reason for transport:
Prolonged labor. There’s a pretty broad range of what “prolonged” means, as every person is different. But generally, for first-time parents, it is not unheard of for contractions to last a day or two or more. When a laboring person says, “I am no longer tolerating labor, and my expectations for cervical change and fetal descent are not being met,” then the option of an epidural can be a lifesaver. It is sometimes assumed that if we are going to the hospital, there will be an “automatic” Cesarean birth. That’s not the case. Many hospital care providers understand that babies take time, and are willing to let our clients “labor down” as long as the birthing person’s vitals are stable, and the baby’s heartbeat is acceptable.
Other reasons we go to the hospital from time to time:
High blood pressure/pre-eclampsia in the laboring person
Fever in the laboring person, or other signs of infection such as malodorous amniotic fluid
Abnormal bleeding, which can happen even in the presence of normal vitals for the laboring person and baby
Category II or III fetal heart rate
Pregnant persons with twins or breech presentation will not be able to birth out-of-hospital with a licensed midwife (however your midwife will give you referrals for some other options)
Controlled gestational diabetes is considered acceptable for home birth. Uncontrolled gestational diabetes or pre-existing diabetes are not options
The laboring person may (rarely) have to go to the hospital after the birth for non-resolving shock, or to get a very deep vaginal tear repaired
The baby may have to go to the hospital (rarely) for signs of potential infection, such as high respirations. There is a very low tolerance for any kind of abnormal in a baby. If a baby is not perfectly stable at a certain point, we go. Sometimes babies go to the hospital for monitoring and are discharged as healthy soon after. If they are not healthy, they are already in the NICU, getting the care they need
Sometimes an emergency arises when there are few to no risk factors. Midwives are trained to handle these emergencies in real time and will activate EMS during the emergency or afterwards, if it does not resolve.
A few examples:
We carry three different kinds of medications to stop postpartum hemorrhage. We also carry IV fluids to resolve shock as a result of a hemorrhage. We can practice active third stage management if you are determined to be more likely to have blood loss
We are able to do basic resuscitation for a newborn baby who does not breathe right away, using a bag-valve-mask for positive pressure ventilation. We carry oxygen for this purpose as well, and can use oxygen for a laboring person, if needed
We are trained and experienced in shoulder dystocia and nuchal cord management