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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
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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
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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
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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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