Homebirth - reasons for transfer...

As some of you here know, I had a son, Seoras, who was born at home
last year. He did not breathe, due to a rare but not unheard of lack
of reflexive breathing instinct. This was not predictable and had he
been born in hospital his survival chances would not have been any
better. Its extremely unlikely to happen again, but if it does
location of birth would have no effect.

Given all that, we are seriously considering another homebirth when I
become pregnancy against. I'm in the process of coming up with a plan
for antenatal care with my next , including transfer criteria.

So far, I have come up with the following: breech, OP, prolonged ROM
(24h+), Mec at ROM, FH +/- 15 on more than one occasion. 2nd stage
transfer will be per 2.7, by private car. Reasons pre-labour (i.e.
induction): pre-Eclampsia as indicated by proteinurea+++ BP X/100.

For those who homebirth, please understand that my criteria are much
more conservative than those without a previous loss.

Anyway, I was wondering if anyone else here has any suggestions for
further reason. I will consider all, but reserve the right to ignore
;-)

Megan
--
Seoras David Montgomery, 7 May 2003, 17 hours: sunrise to sunset (homebirth)

To e-mail use: megan at farr-montgomery dot com

I may sound stupid but do I understand right that your son didn't live?
"Buzzy Bee" wrote in message
...
As some of you here know, I had a son, Seoras, who was born at home
last year. He did not breathe, due to a rare but not unheard of lack
of reflexive breathing instinct. This was not predictable and had he
been born in hospital his survival chances would not have been any
better. Its extremely unlikely to happen again, but if it does
location of birth would have no effect.

Given all that, we are seriously considering another homebirth when I
become pregnancy against. I'm in the process of coming up with a plan
for antenatal care with my next , including transfer criteria.

So far, I have come up with the following: breech, OP, prolonged ROM
(24h+), Mec at ROM, FH +/- 15 on more than one occasion. 2nd stage
transfer will be per 2.7, by private car. Reasons pre-labour (i.e.
induction): pre-Eclampsia as indicated by proteinurea+++ BP X/100.

For those who homebirth, please understand that my criteria are much
more conservative than those without a previous loss.

Anyway, I was wondering if anyone else here has any suggestions for
further reason. I will consider all, but reserve the right to ignore
;-)

Megan
--
Seoras David Montgomery, 7 May 2003, 17 hours: sunrise to sunset (homebirth)

To e-mail use: megan at farr-montgomery dot com

On Sun, 08 Feb 2004 01:14:50 GMT, "Jody Pellerin"
wrote:
but then again I might just have mucked up the snipping as usual!
I may sound stupid but do I understand right that your son didn't live?

Yes, a lack of reflexive breathing instinct is, by definition, fatal.

Megan
--
Seoras David Montgomery, 7 May 2003, 17 hours: sunrise to sunset (homebirth)

To e-mail use: megan at farr-montgomery dot com

On Sat, 07 Feb 2004 21:24:22 -0500, Ericka Kammerer
wrote:
but then again I might just have mucked up the snipping as usual!

Hmm...I'd just add to the list that you'd transfer
any time you felt it necessary.

I think thats worth saying, thanks!

The list of reasons one
would transfer could be endless, including just having a
gut feeling it was the right thing to do.

Probably the best reason of all!

Would you transfer
for OP at any time during labor? Or only towards the end?
Also, would you transfer for *any* degree of meconium?


Yes, on both. But *only* because I have a previous perinatal loss.
Its a comfort issue for me. Were that not the case I would be
unlikely to transfer for either.

Megan
--
Seoras David Montgomery, 7 May 2003, 17 hours: sunrise to sunset (homebirth)

To e-mail use: megan at farr-montgomery dot com

Buzzy Bee wrote:


Given all that, we are seriously considering another homebirth when I
become pregnancy against. I'm in the process of coming up with a plan
for antenatal care with my next , including transfer criteria.

So far, I have come up with the following: breech, OP, prolonged ROM
(24h+), Mec at ROM, FH +/- 15 on more than one occasion. 2nd stage
transfer will be per 2.7, by private car. Reasons pre-labour (i.e.
induction): pre-Eclampsia as indicated by proteinurea+++ BP X/100.

For those who homebirth, please understand that my criteria are much
more conservative than those without a previous loss.

Anyway, I was wondering if anyone else here has any suggestions for
further reason. I will consider all, but reserve the right to ignore
;-)


Hmm...I'd just add to the list that you'd transfer
any time you felt it necessary. The list of reasons one
would transfer could be endless, including just having a
gut feeling it was the right thing to do. Would you transfer
for OP at any time during labor? Or only towards the end?
Also, would you transfer for *any* degree of meconium?

Best wishes,
Ericka

Buzzy Bee wrote:

On Sat, 07 Feb 2004 21:24:22 -0500, Ericka Kammerer
wrote:

Would you transfer
for OP at any time during labor? Or only towards the end?
Also, would you transfer for *any* degree of meconium?

Yes, on both. But *only* because I have a previous perinatal loss.
Its a comfort issue for me. Were that not the case I would be
unlikely to transfer for either.


Is it because the risks of these things are
higher because of your loss, or is it because you just
(understandably) want to be more conservative as a
result of the loss? If the latter, I would be inclined
to leave these things off your list (or moderate them)
such that your list only includes the things that you
truly believe to be medically risky. Then, I would
put in the plan (and discuss with caregivers) that
I expected support for wanting to transfer for lesser
reasons if I felt like it. The reason I suggest this
is that it leaves doors open in case your feelings
are different from what you expect while in labor.
For instance, if the baby is OP, but you're feeling
great and positive about the labor and want to continue
staying at home, do you want to be re-negotiating your
birth plan on the fly? I'm in favor of minimalist
birth plans so that they don't become cluttered and
unfocused. By eliminating things that are there
more because of feelings than because of medical
evidence, but then asserting your right to transfer
for *any* reason, you cover all your bases without
removing your flexibility. Just a thought...

Best wishes,
Ericka

On Sat, 07 Feb 2004 22:09:06 -0500, Ericka Kammerer
wrote:
but then again I might just have mucked up the snipping as usual!

Is it because the risks of these things are
higher because of your loss, or is it because you just
(understandably) want to be more conservative as a
result of the loss?

The latter.

If the latter, I would be inclined
to leave these things off your list (or moderate them)
such that your list only includes the things that you
truly believe to be medically risky. Then, I would
put in the plan (and discuss with caregivers) that
I expected support for wanting to transfer for lesser
reasons if I felt like it. The reason I suggest this
is that it leaves doors open in case your feelings
are different from what you expect while in labor.
For instance, if the baby is OP, but you're feeling
great and positive about the labor and want to continue
staying at home, do you want to be re-negotiating your
birth plan on the fly? I'm in favor of minimalist
birth plans so that they don't become cluttered and
unfocused. By eliminating things that are there
more because of feelings than because of medical
evidence, but then asserting your right to transfer
for *any* reason, you cover all your bases without
removing your flexibility. Just a thought...

Well, this is the list I propose to show to my GP, who has f*** all to
do with my antenatal care in reality but wants to put an oar in. DH
has in fact persuaded me to simply say "not up for discussion until
32/40" which is probably much more sensible, but its a good exercise
for me in that it does make me think about why I would wish to
transfer. Plus I can, if necessary, reassure them that I am not going
into this determined to have a homebirth regardless and am seriously
considering the circumstances under which I would transfer.

I am pretty confident my midwife will support me in anything as long
as she thought I was making an informed choice. She has said as much.
So renegotiating with her isn't an issue and I don't plan to have a
birth plan with her, just as I didn't last time. No need and I
changed my mind on all sorts of things anyway. This is the public one
and eventually, I guess be incorporated into the transfer plan
(because I then need to consider what I would want after transfer).

Megan
and no, I am not even pregnant, but thats not stopping the GP.
--
Seoras David Montgomery, 7 May 2003, 17 hours: sunrise to sunset (homebirth)

To e-mail use: megan at farr-montgomery dot com

Megan,
I don't really have any advice for you, but my prayers are with you, hon.
I'm 18 weeks pg with my sub-bub, having lost my son at 29 weeks at the end
of 2002. I can tell you it's an emotional minefield, regardless of what
choices you make. Labour for me is not really considered more risky, but
I've chosen to have a hosp. birth with a specialist on call in addition to
my midwife. I guess just because after you've had one thing go wrong, you
hear of all the other things that can go wrong, etc etc...
I admire you though for going for the birth you want, and keeping it as
natural and relaxed as possible. Good luck with whatever you decide.
~Amy
Mum to Carlos, born sleeping 20.11.02 & another on the way

"Buzzy Bee" wrote in message
...
As some of you here know, I had a son, Seoras, who was born at home
last year. He did not breathe, due to a rare but not unheard of lack
of reflexive breathing instinct. This was not predictable and had he
been born in hospital his survival chances would not have been any
better. Its extremely unlikely to happen again, but if it does
location of birth would have no effect.

Given all that, we are seriously considering another homebirth when I
become pregnancy against. I'm in the process of coming up with a plan
for antenatal care with my next , including transfer criteria.

So far, I have come up with the following: breech, OP, prolonged ROM
(24h+), Mec at ROM, FH +/- 15 on more than one occasion. 2nd stage
transfer will be per 2.7, by private car. Reasons pre-labour (i.e.
induction): pre-Eclampsia as indicated by proteinurea+++ BP X/100.

For those who homebirth, please understand that my criteria are much
more conservative than those without a previous loss.

Anyway, I was wondering if anyone else here has any suggestions for
further reason. I will consider all, but reserve the right to ignore
;-)

Megan
--
Seoras David Montgomery, 7 May 2003, 17 hours: sunrise to sunset
(homebirth)

To e-mail use: megan at farr-montgomery dot com

Buzzy Bee wrote:


Well, this is the list I propose to show to my GP, who has f*** all to
do with my antenatal care in reality but wants to put an oar in. DH
has in fact persuaded me to simply say "not up for discussion until
32/40" which is probably much more sensible, but its a good exercise
for me in that it does make me think about why I would wish to
transfer. Plus I can, if necessary, reassure them that I am not going
into this determined to have a homebirth regardless and am seriously
considering the circumstances under which I would transfer.


Ahhh, then by all means do whatever seems necessary
to manage your GP ;-) Just keep a careful eye on it that
it doesn't become a document he can hang you with ;-)


Best wishes,
Ericka

Just a clarification question... what do you mean by: FH +/- 15?

Jo (RM)

Buzzy Bee wrote:
SNIP

So far, I have come up with the following: breech, OP, prolonged ROM
(24h+), Mec at ROM, FH +/- 15 on more than one occasion. 2nd stage
transfer will be per 2.7, by private car. Reasons pre-labour (i.e.
induction): pre-Eclampsia as indicated by proteinurea+++ BP X/100.

SNIP

Megan

--
--
Babies are Born... Pizzas are delivered.