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hospital transfer



 
 
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  #1  
Old November 1st 08, 01:38 AM posted to misc.kids.pregnancy
Anne Rogers
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Posts: 1,497
Default hospital transfer

maybe some of you who've planned or considered homebirths in the USA can
give me a perspective on this, I've been reading through the
documentation from the midwives on informed consent, one of the things
is transfer to hospital and that in an emergency it would be 911 to the
ER. This worries me, the local hospital is quite big, maternity and the
ER are quite a way apart, the ER is on the ground floor quite away from
the main hospital tower, where maternity is on the top floor. I guess
it's a 10 minute push on a trolley!

When weighing up the pros and cons of out of hospital birth in the UK,
one of the things that is very clear is that if you transfer in an
emergency the midwife will be in contact with the delivery suite and an
ambulance would take you to wherever the drop off point is for that
section of the hospital (UK hospitals tend to have the main ambulance
drop off at A&E, but multiple ones around the site for getting patients
to other wards, if the admission isn't by the patient calling an
ambulance, but say a doctor deciding it's needed then calling a non
emergency or emergency, as the case may be, ambulance to transfer). So
the transfer time to the hospital can be estimated by the average time
to get an ambulance to you and get to the hospital, then a very short
pushing the trolley when you get there, the lifts are usually right by
the entrances and the units on higher floors are generally right there
when you get out the lift.

In the information they are quick to remind you that most transfers are
not an emergency, but that isn't really the point, the last thing you
want on the off chance an emergency should occur is to get to the
hospital and only at that point then waste 10+ minutes as you work your
way through the system, because if it really were an emergency that time
would be valuable. Same with transferring a baby, if resus beyond what
the midwives can offer is needed, in the UK babies would be transferred
directly to SCBU, again they call ahead and although there are special
neonatal ambulances they are usually for hospital to hospital transfer
so the baby would likely arrived in a normal ambulance, but if they are
expecting a sick baby, they get a team right there in the foyer. I am
aware of reports of babies dieing because ambulance teams failed to
follow instructions as to where to go and the time delay may have
contributed.

My logic behind out of hospital birth as roughly been, there is no
evidence that it's any more risky, and should an emergency happen there
isn't necessarily any difference in getting help particularly if, as we
did, you live near where an ambulance is stationed and they get to you
fast and to the hospital fast. Now, my crutch has been whipped away, I
still thinking it's overall safer, but the rare what if scenario
suddenly seems a lot scarier!

Cheers
Anne
  #2  
Old November 1st 08, 01:56 AM posted to misc.kids.pregnancy
Ericka
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Posts: 64
Default hospital transfer

Anne Rogers wrote:

My logic behind out of hospital birth as roughly been, there is no
evidence that it's any more risky, and should an emergency happen there
isn't necessarily any difference in getting help particularly if, as we
did, you live near where an ambulance is stationed and they get to you
fast and to the hospital fast. Now, my crutch has been whipped away, I
still thinking it's overall safer, but the rare what if scenario
suddenly seems a lot scarier!


First things first, you need to ask the midwives what
their experience is with transfers, rather than the nit-picking
legalese in the handouts. Secondly, the ambulance staff will
also be calling ahead to the hospital and making arrangements
for whatever makes the most sense. And remember, the ER is
set up for a variety of emergencies.

Best wishes,
Ericka
  #3  
Old November 1st 08, 02:32 AM posted to misc.kids.pregnancy
Anne Rogers
external usenet poster
 
Posts: 1,497
Default hospital transfer

First things first, you need to ask the midwives what
their experience is with transfers, rather than the nit-picking
legalese in the handouts. Secondly, the ambulance staff will
also be calling ahead to the hospital and making arrangements
for whatever makes the most sense. And remember, the ER is
set up for a variety of emergencies.


Thanks for calming me down! Obviously in just one meeting we didn't talk
about everything, but she did talk about having contacts at the hospital
and even the option of transferring to midwifery led care at the
hospital (as I understand it there is one midwife who has delivery
priviledges), but we didn't talk about emergencies.

I've even gone to that hospital in an ambulance, I was pretty unwell
then, but now thinking back I do remember them having radio contact.

It's really hard for me having only lived here 2 years to be able to
contrast things that are really quite similar superficially, I've seen
inside 2 ERs here and they look just like the ones I've seen in the UK
and they appear to function the same way. But there are obvious
differences, for example in the UK they would rarely have dedicated
imaging facilities, other than x-ray. They also really don't like to
deal with pregnant women and a woman in labour would only rarely walk
into the ER, in theory you should call ahead and go to the unit, but
staff have told me they always get some come to the door who are booked
with them, they just failed to follow instructions and a fair number who
just show up at the door and they wouldn't turn them away or make them
jump through hoops. So the idea of showing up at the ER with a labour
emergency scares the heck out of me because I can't get my head round
that anyone there might have a clue, because in the UK, chances are they
wouldn't.

I'm really glad of the frequent appointment schedule there is so much to
get my head round, my previous pregnancies the schedule has been booking
at around 8 weeks, then 16 weeks, 24 weeks, 28 weeks, 32 weeks, 34, 36
etc. and possibly less than that for a straightforward 2nd pregnancy, I
was on weeklies at the end because with a previous IUGR baby and a very
small bump, she wanted to check it grew each week, which it did and then
suddenly got enormous (well average really, but it felt enormous to me
having never got bigger than normal for 7 months pregnant before).

Thanks for reassuring me Ericka, my husband was getting concerned too,
he was lucky enough to be in Santa Barbara recruiting at the beginning
of the week, which gave him a chance to meet old friends, who like us
had two babies two years apart in the UK followed by a 4 year gap and a
birth in the US. She's American, but he is English and unlike other
friends who've had babies in both countries, she was anxious over the US
system rather than reassured - I get the impression she would have liked
a homebirth with a midwife, but her FIL is an obstetrician and it was
just a no go area with her husband.

I think I need to go check out mothering.com!

Cheers
Anne
  #4  
Old November 1st 08, 03:13 PM posted to misc.kids.pregnancy
betsy
external usenet poster
 
Posts: 234
Default hospital transfer

Anne Rogers wrote:
maybe some of you who've planned or considered homebirths in the USA can
give me a perspective on this, I've been reading through the
documentation from the midwives on informed consent, one of the things
is transfer to hospital and that in an emergency it would be 911 to the
ER. This worries me, the local hospital is quite big, maternity and the
ER are quite a way apart, the ER is on the ground floor quite away from
the main hospital tower, where maternity is on the top floor. I guess
it's a 10 minute push on a trolley!


I don't live in a large metropolitan area, so things aren't the same,
but I have had an emergency transfer. In my case, about an hour after
the birth, during which my midwife had tried to deal with my bleeding
which was getting worse, she said something like "you're bleeding too
much, I think we have to call 911 for an ambulance to get you to the
hospital."

I assessed how I felt and said "I can walk out to the car now." They
quickly yanked on a nightgown, the the weird ob underwear&pad, and my
snow boots (which immediately filled with blood) and we went. As soon
as we were driving, with me reclined and my feet up on the dash, my
midwife called the hospital by cell phone, telling them the situation
and that we were about 2 1/2 minutes out and that she would be bringing
my to the hospital entrance right by the birth center.

By the time we arrived, they had two people with a wheelchair who ran
out to the car, wheeled me in at a run, and deposited me in a room of
nurses, nursing students, and their teacher, a former British midwife.
They immediately took things in hand.

I feel that I was well taken care of in the hospital. The on call OB
was very nice. I couldn't have my own backup doctor because she
practices at a hospital ten miles away and there clearly wasn't time to
drive there.

What actually happened and what was written in the contract were a
bit different, though we followed the plan in going to the close
hospital for an emergency transfer.

--Betsy
 




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