Home Birth Safety

From Planned Home Birth to “High Risk” Hospital Patient

1 Comment 26 October 2011

guest post by Kim

30 healthy weeks into my second homebirth-planned pregnancy, I blithely walked into Children’s National Medical Center for a fetal echocardiogram with my husband.

We were confident and cocky.

I had given birth to my first son at a freestanding birth center, intervention-free and midwifery-supported. We had no risk factors for birth defects and I had remained active and eaten an impeccable diet prior to and after conception. Our midwife had assured us that the baby’s heart tones were normal and showed wide variation.

What could possibly go wrong?

No parent wants to hear the dreaded words “high-risk pregnancy”.

For me, this label packs an especially painful punch, as it requires birthing in a hospital and conjures up images of Monty Python’s “Machine That Goes Ping” skit.

The only reason that I did not birth my firstborn at home was because our tour of the hospital nearest our home was a homebirther’s nightmare: white walls, scary lighting, continuous fetal monitoring, required bed labor…I ran out of there in tears and vowed that I could not risk a scenario in which I ended up there for any reason.

Since discovering my baby’s functional heart condition, I went through a predictable progression of emotions that I tried to use to secure the best, most appropriate, and most personalized care possible.

I am still on my journey, and I hope that in a few weeks, I can return and shout, “Success!” Along the way, I have learned a few tricks of hospital transfer. I hope that you never have to use them.

Day 1-3: Anger/Denial/Grief

Why did I trust that ultrasound machine? (Cue every study that has called into question the efficacy and accuracy of ultrasound) What if it is raising the specter of a risk for no reason? Am I sacrificing my homebirth to a what-if situation?”

At this point in the journey, I was in no emotional condition to deal with the logistics of transfer, but felt overwhelmed by the sheer magnitude of change required.

And who could blame me? Suddenly the safe haven of birth at home is not safe, but the very real risks of hospital birth remain. Why do doctors worry to such a great extent about things like proximity to a NICU but don’t give a second thought to the increased risk of fetal distress that directly results from so many of the interventions that hospitals use so cavalierly?

“I am not going to reprise the joy of that first birth.”

This is when the educated choice of a midwife or midwifery practice comes into effect. Hopefully, you have already researched your midwife’s community connections prior to becoming her client (hint to all moms planning out-of-hospital birth).

I did not directly, but lucky for me, the Bradley instructor that guided me to my midwifery practice six years ago did. My primary midwife knew exactly what strings to pull in order to find professionals who could meld my birth philosophy with my medical needs.

She spent two mornings calling fellow CNMs, CPMs in the area, and labor/delivery nurses to find out the cafeteria gossip on who could support a birth such as mine and what hospital would be most able to accommodate ALL of my needs. I, on the other hand, spent the same two mornings burying my face in a box of Kleenex and calling my doula-turned-therapist (Thanks, L.S.).

Day 4-7: Fear

“All of those studies showing the increased risks associated with common hospital interventions are still relevant, and now I have to face them head-on.”

In some cases, common hospital interventions might even put you or your child at increased risk of complications as compared to a low-risk motherbaby pair. This is certainly the case with my baby, although none of the doctors involved in my care have so much as hinted at it. Why would I want my baby, who is already at risk for fetal distress in labor, to be exposed to narcotics or induction drugs?

I was able to exit the fear phase by touring my birth hospital.

Apparently, not all hospitals are like a terrifying Halloween experience. My original midwife was able to find a mother-friendly hospital whose 35% cesarean rate is most likely attributable to the Housewives-of-?-County women in this area who request early inductions and c-sections as a matter of convenience.

No scary, dangerous hospital policies, no bright lights, and L/D nurses who actually have familiarity with natural birth. I actually saw birthing balls and stools in the L/D/R rooms! I even heard the moans of a mother in transition as we toured. What a beautiful sound.

Day 8: Suspicion

“Are these new midwives really medwives? Does my parinatologist laugh behind my back at my birth plan?”

Here is where it is most helpful to have a doula; if possible, one who has worked with you throughout your pregnancy and knows your birth values inside-out.

I have taken to emailing mine regularly with updates, and she is able to place my experiences in the context of other women who have had to manage similar situations.

Having someone from my original birth plan and previous labor to bring into the new situation has been invaluable in helping me learn to trust these strange new care providers.

Day 9-Birth: Faith

“This is not what we had planned, but this is doable. I can do this, my baby can do this, and we have the support to have the birth we wanted in the safest way possible.”

It has been tough to realize that I do not have to see eye-to-eye with everyone on my healthcare team. I have had to compartmentalize my relationships with my fetal cardiologist, perinatologist, and even my new midwives.

My care is no longer all-in-one, but it is midwifery, and I can still have a safe, gentle, unmedicated birth. The high-risk committee will not be there when I push my son into his daddy’s hands. I have to get over the fact that some of them will be waiting in the hall to check over my baby, and that hours later my baby will have to go to the NICU with Daddy for testing that I never even knew existed until now.

I just might cry when I go to the breastfeeding boutique to rent a pump in case my breasts can’t handle a few hours of separation. I can do this, and my baby can do this.

We are not high-risk; we are high-touch.

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1 comment

  1. Christie B says:

    *Hugs* It seems like you are already doing wonderfully with unexpected and somewhat frightening news. I would have a hard time too going to the hospital after my homebirth. It’s so easy to lose sight of the fact that statistically it’s a close call in low-risk pregnancies and that in a high-risk pregnancy the hospital really is a fantastic place we’re so privileged to have access to. You’re so smart to be focusing on making sure you’re prepared for breastfeeding. The preparation can make such a difference there!

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