Unplanned home births

[RainbowRiver]

I have a few questions if anyone can answer them or share their experiences!

1. If you should have an unplanned hb, who do you call afterwards (Ambulance or hospital etc)?
2. What gets put on the birth form where it asks for attending dr or midwife?
3. Do you have to go to hospital?
4. What items do you need on hand JIC you end up with unplanned birth?
5. What do you do with the cord (clamping wise)?

Thanks

[CinderToriella]

I had an unplanned car birth with my DD2 just 5 weeks ago

1. We called an ambulance and hospital .
2.the midwife or dr who looks after you when you go to hospital after the birth , their names gets put down .
3. We did .up to you I guess .
4.all we had was blankets a hat for DD2
5.left the cord, ambulance said they normally clamp cut it when they get there but with me they left it as it was and hospital did it .

[HotI]

you don'thave to go to hospital, but the ambos will want you to.

you don't have to do anything to the cord.

if you choose not to go hospital, you are classified as having a freebirth. in order to register the birth, you write s stat dec, your partner or other witnesses write a stat dec stating that you gave birth to a liveborn boy/girl at date/time at place (youraddress). additionally, amother person writes a stat Dec who saw you when you were pregnant and saw you with the baby.- could be gp or chiro or just friend.
these get submitted to BD&M for your birth certificate. when your birth certificate arrives, you can then submit forms to centrelink. it takes around 2 weeks longer this way, than when everything is submittedat same time.

[Arcadia]

This is a side point so sorry to hijack, but I think there should be a 'mobile midwives' service associated with each hospital for this kind of situation. It is silly to me that an ambulance is often the first port of call when Ambos don't have specialist training (there was a great article on this in the Age last year so I'm being Victorian biased).

If it were me:
1. I would call one of the midwives I know or the hospital to ask what to do next.
2. The form depends on whether you go to hospital or not. If not then you can get a GP to sign a stat dec saying you had the baby and to help you register the birth.
3 I would always opt for post natal care even if its a day or two after the birth. It could be hospital a midwife or a GP who can do a home visit.
4. I would have blankets towels and clothes for baby.
5. Don't touch the cord. There is no need. The placenta will come out and then you can cut it when you get some help or get some advice.

[TeniBear]

Just on the cord thing - everyone's right in that you should leave it (even in a supervised birth it's better!) BUUUUT you should probably have something on hand like some clean thread to tie it off in the (extremely unlikely, minuscule) event it breaks or has a tear in it. As I said, it's not likely at all, but there's always that tiny tiny chance of something happening.

[~ Zarava Flutterby ~]

On my phone but will come back and answer from my experience a little later

[nickle730]

Hey Rosetti, I am a paramedic. We are called every now and then to unplanned home births. If you wish to see the average ambo in a panic, call for an ambulance with an imminent delivery! Whilst as a service we receive these calls regularly, the average individual paramedic will likely only deliver a few babies in their career. In my 15 years, I claim 9 (lol... 4 of those were already delivered by the time we got there, but I'll claim them anyway!) and that is considered a massive number. Unfortunately, many of the deliveries we are called to are for very prem labour and the outcome is often not good if delivered at home. The other calls we generally receive are for women whose labour progresses far more quickly than they expect. We also receive calls from women in early labour whose labour plan is to call an ambulance instead of a taxi or a friend. This is not an appropriate use of an emergency ambulance, but I digress.

If you deliver unexpectedly at home and call an ambulance, I will expect that you wish to be transported to hospital. Once you call me, I have a duty of care to you and in this case the only way to fulfil that duty of care is to transport you to specialist care so that you and your baby can be assessed by a professional qualified in this area. Telling the coroner that you just didn't want to come won't save my job and nor would it let me sleep at night if you are left unmonitored and something happens to you or your newborn. The other occasion in which an ambulance is called to assist a delivery is a home birth which is not progressing as planned. Again, you have been presented with a situation which has necessitated you calling an emergency ambulance, it follows that you need to be assessed in hospital even if we manage to deliver your baby at home. The only situation where I can imagine leaving a mother and newly born baby at home would be in the case of a planned homebirth. I would defer to the opinion of a suitably qualified midwife on scene and if I was satisfied that the emergency had passed I might be comfortable leaving you in the care of that midwife. I am not aware of any woman who has called an ambulance for a delivery and then wanted to remain at home.

Leave the cord alone. We generally clamp and cut the cord prior to transport if you deliver at home, or after delivery if you deliver in the back of the truck. Assuming the baby has a good 1 min APGAR, I am happy to delay the clamping if it is the mother's request.

We do receive obstetric training. I believe the student's coming through now spend almost a term on obstetrics. Not much compared to the three years MW's study for! When I trained, I also spent a placement at the RWH observing and assisting (where the mother was agreeable) with both vaginal and cesarian deliveries. But where a midwife will assist with hundreds of deliveries a year, I have assisted 9 on road in 15 years - I know who I would rather have assisting my birth!

I have read here on BB on several occasions 'ah well, if it turns to poo we'll call an ambulance'. This is not a good plan. Certainly, in an emergency we have the training and the equipment to assist you, but we simply don't have the experience or the exposure to be a good substitute for a well planned home birth or a delivery in hospital monitored by experienced MW's or an OB. I am not discouraging anyone from calling an ambulance for assistance with a birth, but we should be a last resort in an emergency not a part of your birth plan.

If you do need to call an ambulance, hopefully it will be me - I LOVE a childbirth and have considered returning to uni to study midwifery. I'd love to come and help you!

[Nelle]

Twice I've called an ambulance (once they arrived after the birth, and once they arrived in time to sprint me to the hospital with minutes to spare). =)

Personally I'd try to make it to hospital, just for the reasons Nickle stated—I love and appreciate knowing that paramedics are ready to come out and help, but they're not midwives and bless them, some can get a bit panicky (they try to hide it but when they are practically begging you to hurry and get to hospital, you know they REALLY don't want to be the ones in charge lol. And fair enough!).

So, I guess if I realised things were really happening and a car wasn't an option, I'd call an ambulance and hope to make it. The only time I wouldn't get IN the ambulance would be if I was pushing already, because it takes me about 10 minutes to do that and I'd rather birth at home than in an ambulance, and it makes no difference in terms of who is attending. Otherwise I'd hope to make it. I'd also try to be on speakerphone to a midwife, for a bit of guidance and peace of mind for everyone. If an expert can't be there, then at least having them consulting would be ace.

If the baby was already born, I think I'd still call an ambulance (if I didn't feel up to being driven), because I have no idea how I'd be able to tell if I'd torn, and I wouldn't mind being checked for blood loss, having baby checked over, etc. That's me, based on what's happened with previous births, those are things I don't think I'd feel up to monitoring and managing on my own. Maybe others would feel more confident to be independent there, but I wouldn't mind seeing a midwife I think. So, you don't HAVE to go to hospital, I'd just encourage you to consider, if you bleed, if you tear, if baby is a bit jaundiced, if you go into shock from a speedy delivery—are you resourced enough to identify that, and deal with it? I don't want to be alarmist or anything. Just have a plan, Stan.

I think the paramedics will call the hospital to tell them you're coming, so you don't necessarily have to call the hospital. I think mine called the hospital. They were on the phone to someone, lol.

I think on the birth form, they put the midwife who saw me when I got to hospital? If you didn't go to hospital (and you don't have to) I guess they wouldn't put a midwife?

As for having things on hand, your usual birth aids (for massage, relaxation, thirst, comfort), plus a few towels and a blanket. One towel to clean baby off, another to wrap baby in for warmth, and then a blanket for you both.

I've heard leave the cord (had not heard the thread thing, not hard to have thread on hand though!), but I guess if you weren't going to hospital you'd want to read up more about what you'd want to plan longer term.

There is a cheapish book (maybe free in pdf form, I'm not sure) called Emergency Childbirth, that might help you sort things in your mind as well. Just to help you identify what you are needing to consider (though with 4 kids of your own, I imagine you probably have a good idea of what to think about).

So there's my random thoughts. Based on past experience, I'd try to make it to hospital, because paramedics are not midwives. But if it all happens before you can blink, I've read that most full term babies that just come in a hurry tend to be pretty straight forward, and hopefully (with a bit of just-in-case preparation) you'll be fine. I can't imagine having the baby at home without then getting someone with a bit more expertise involved, but that's just me, and I'm sure a previous PPH and tear and shock and big babies and so on, absolutely influence that mindset. If you feel confident that you are equipped to identify any issues that might crop up and have the resources to deal with them, then it's definitely your call.

[Arcadia]

Just wanted to so thanks nickle for your post. It really helps to hear you write that. Even more reason there should be a mobile midwife service or a specialist obstetric paramedic service (thank call the midwives). There were more unplanned home/car births in victoria in 2008 than planned homebirths so it seems silly that we don't plan for it (don't know the current stats).

I think people need to understand birth is not necessarily an emergency and an ambulance will transport you to hospital.

Do any Obstetricians make house calls anymore? My dad is a country GP and housecalls use to be part of every day life. It seems to be a practise very much extinct.

[HotI]

If you deliver unexpectedly at home and call an ambulance, I will expect that you wish to be transported to hospital. Once you call me, I have a duty of care to you and in this case the only way to fulfil that duty of care is to transport you to specialist care so that you and your baby can be assessed by a professional qualified in this area. Telling the coroner that you just didn't want to come won't save my job and nor would it let me sleep at night if you are left unmonitored and something happens to you or your newborn.

Even the ambos play the dead baby card. noice.

[glenny_c]

Did you even read the rest if her post where she said she would be confident to leave you if you were in the care of an experienced midwife?
Too right she played the "dead baby card". As rare as it may be- babies sometimes die. Only someone who had never held a dying baby would think that it's a "card" to be played. Be thankful it's not your job to be responsible for so many lives.

[Arcadia]

I think the issue of responsibility is important here. If you call an ambulance you defer responsibility to them and you should ask yourself is that what you want.

The death of a baby is never a card to be played, but it is an issue homebirthers get confronted with when we discuss our birthing plans with many people. By birthing at home we assume responsibility for our own and our baby's health, and if a midwife is present they share the responsibility.

If you birth unassisted and call the ambulance or go to hospital you transfer the responsibility to those personnel. Again a reason why women need a health care provider who can come to them!!! I think it's ridiculous there is no one for women to call who have specialized training in obstetrics.

[RainbowRiver]

Nickle, thank you for the very detailed reply, it's great to read your thoughts from a paramedics view and I learnt a lot. I take my hat off to you guys, amazing people and emotional job

Thank you to everyone else too, your experiences are exactly what I wanted to hear.

[HotI]

Did you even read the rest if her post where she said she would be confident to leave you if you were in the care of an experienced midwife?

I did thanks. I also believe a woman has the right to choose. She has the right to call an ambulance or any other health professional and not have to accept everything they offer. Fine to talk about the reasons the HP recommends that you transfer, not fine to insinuate that your child will die if you don't follow my directions when there is no medical reason for that conclusion.

I think the issue of responsibility is important here. If you call an ambulance you defer responsibility to them and you should ask yourself is that what you want.

I disagree. Just because i call an ambulance does not mean i forfeit my rights of decision. Just because i enter a hospital, does not mean i accept all procedures that may be offered. Just because i invite a midwife into my home does not mean that i need to follow all her directions. Health professionals should be able to discuss why they are recommending a course of action, and benefits and risks of accepting or not the action, without threats of explaining to the coroner.

[glenny_c]

I agree that a woman ALWAYS has the right to choose. My problem is with dismissing hp's fear as a "card" to be played.
When you have experience of bad outcomes it is very difficult not to let that colour your behaviour. What's wrong with explaining that risk? What do you think the ulterior motive is here?
Of course no one should be transferred without their consent but I can understand a paramedic being reluctant to leave a new mother and baby without adequate medical care. And if it was an unplanned home birth you could assume mum and dad aren't adequately prepared to deal with potential issues, or even recognise them.
I am not disagreeing with anything you said about woman's rights. I'm taking issue with the dismissive way you referred to a health professionals concerns as "playing a card".

[HotI]

I think we should name it. Health professionals should be called on it when they are using outcomes not supported by the evidence to coerce patients into actions.

I also understand that Nickle is not talking here to a patient, and that may not be how she would talk to a patient she was caring for, but i still find her comment inappropriate.

I have a good friend that is an ambo. I love her. I would not want her coming to my homebirth unplanned or planned. Ambos behaviour and thoughts are also coloured by their experiences, and i do get that. But if we have healthy mum with a healthy baby, in the case of the OP it would be her 4th baby, I don't see that discussion of the coroner is neccesary. Ambos and other health professionals have cover my butt clauses when a person refuses their help. If the risk is life threatening, and they believe the person is unable to make a rational decision then they also have options available to them.

[glenny_c]

See, I don't see it that way at all. And that is perhaps coloured by my experience. Well, not perhaps- definitely coloured.
I don't see talking about a coroner as a threat, I see it as discussing a risk. You say a healthy mum and baby. I say, there is no one qualified there to make the assessment that they are healthy. Sometimes it's impossible to assess that properly.
My son was born healthy, or so I thought. Apgars of 8 and 9. Fed straight away. 6 days later he was in heart failure and bring rushed into his first open heart surgery. In my case, even the drs at his birth were happy that he was healthy. I'm not sharing that to scare anyone but to try and explain where I'm coming from.
I can understand why doctors would share the risk of mother or baby fatality when they have experienced it. They are human as well and are desperate not to repeat the situation. As I said, it may be a small risk, but it's there. Especially in an unplanned free birth situation where no midwife is present.
I know health professionals have ways to legally cover themselves if their advice is not followed but I would suggest that they ate mostly not thinking about the legal ramifications, rather the months of sleepless nights and guilt.

[Little Chicken]

I don't think she is playing the dead baby card in that sense. I read it that she is saying that the person obviously felt the need to call an ambulance, and barring there being professional qualified help already on site, then she feels the best course of action is to go to hospital to at least be checked out. Because you know, health professionals have to live with their decisions, and have a tendency to replay things in their heads over and over again. And yes, one bad incident can affect how you deal with future scenarios, so maybe cut her some slack.