Unplanned home births

[Arcadia]

I think this discussion has become unhinged by the gap between a health professional offering objective care to a person versus the subjectivity of the health professional (their experiences and fears) impacting on the decisions they make or choices they make available to a patient (stay with me here because i know all experiences will impact hp). In this case, bringing up the coroners court becomes a 'card' because it is an emotive and subjective experience linked to the health professional that is used with moral weight to push the decision making processes of the mother. I agree we all need to know risks, but in a highly emotive situation like birth bringing up litigation and the subjective experience of the hp doesn't help.

Now I know this isn't a real- life situation and no hp is truly offering advice here in a professional capacity, but I can see how it plays into the same old 'dead baby card' issue homebirthers always face. I have already thanked Nickle for her informative post and I really appreciate how her own subjective experiences necessarily influence her opinions. My dad is a GP, my sister a nurse, their experiences have undoubtedly impacted their treatment of patients. I think when it is blatantly put to a person that 'hey this is what I've seen so be warned' it skews their autonomy to make a rational decision, because now they're weighed by your experiences and not by broader risk analysis or facts (and I think this is why obstetrics in general is going towards more medical models, because the rare complications start informing the majority).

As for refusing Ambos treatment or other health professional, I think this is a grey and scary area (for my brain anyway). I can't see why you would call 000 and then refuse treatment offered BUT I think a woman should always be able to refuse treatment from any hp. I think it is dependent on expectations and understanding of what that hp offers, as well as trust in that hp, which ultimately they need to instill in you.

[Mum2twoBoys]

I think this discussion has become unhinged by the gap between a health professional offering objective care to a person versus the subjectivity of the health professional (their experiences and fears) impacting on the decisions they make or choices they make available to a patient (stay with me here because i know all experiences will impact hp). In this case, bringing up the coroners court becomes a 'card' because it is an emotive and subjective experience linked to the health professional that is used with moral weight to push the decision making processes of the mother. I agree we all need to know risks, but in a highly emotive situation like birth bringing up litigation and the subjective experience of the hp doesn't help.

Now I know this isn't a real- life situation and no hp is truly offering advice here in a professional capacity, but I can see how it plays into the same old 'dead baby card' issue homebirthers always face. I have already thanked Nickle for her informative post and I really appreciate how her own subjective experiences necessarily influence her opinions. My dad is a GP, my sister a nurse, their experiences have undoubtedly impacted their treatment of patients. I think when it is blatantly put to a person that 'hey this is what I've seen so be warned' it skews their autonomy to make a rational decision, because now they're weighed by your experiences and not by broader risk analysis or facts (and I think this is why obstetrics in general is going towards more medical models, because the rare complications start informing the majority).

As for refusing Ambos treatment or other health professional, I think this is a grey and scary area (for my brain anyway). I can't see why you would call 000 and then refuse treatment offered BUT I think a woman should always be able to refuse treatment from any hp. I think it is dependent on expectations and understanding of what that hp offers, as well as trust in that hp, which ultimately they need to instill in you.

Yes I cop a bit of flack for being a nurse and having a hb. But I think that everyone has the capability of educating themselves. But what you've said might ring true, in regards to experiences affecting hp methods. I, tap wood, have never had to deal with the unexpected death of one of my patients, but have dealt with patients loss of autonomy. And so with my nursing, I find that I try to be as holistic as possible and give all the facts, without using scare mongering. I know it's a bit off topic, but makes me wonder, if I do my midwife training, am I likely to want to be an IM due to being an advocate for hb. I like the idea of working in a hospital, educating mothers and pushing for their rights. But in this day and age, am I likely to feel pushed out by other hp who are all about protecting their jobs and the hospital, rather than the patient?

[nickle730]

I think this discussion has become unhinged by the gap between a health professional offering objective care to a person versus the subjectivity of the health professional (their experiences and fears) impacting on the decisions they make or choices they make available to a patient (stay with me here because i know all experiences will impact hp). In this case, bringing up the coroners court becomes a 'card' because it is an emotive and subjective experience linked to the health professional that is used with moral weight to push the decision making processes of the mother. I agree we all need to know risks, but in a highly emotive situation like birth bringing up litigation and the subjective experience of the hp doesn't help.

Now I know this isn't a real- life situation and no hp is truly offering advice here in a professional capacity, but I can see how it plays into the same old 'dead baby card' issue homebirthers always face. I have already thanked Nickle for her informative post and I really appreciate how her own subjective experiences necessarily influence her opinions. My dad is a GP, my sister a nurse, their experiences have undoubtedly impacted their treatment of patients. I think when it is blatantly put to a person that 'hey this is what I've seen so be warned' it skews their autonomy to make a rational decision, because now they're weighed by your experiences and not by broader risk analysis or facts (and I think this is why obstetrics in general is going towards more medical models, because the rare complications start informing the majority).

As for refusing Ambos treatment or other health professional, I think this is a grey and scary area (for my brain anyway). I can't see why you would call 000 and then refuse treatment offered BUT I think a woman should always be able to refuse treatment from any hp. I think it is dependent on expectations and understanding of what that hp offers, as well as trust in that hp, which ultimately they need to instill in you.

Arcadia, I understand and agree with what you are saying. It is impossible not to be affected - professionally and personally - by past experiences and this helps to form our view of future experiences. I think this is true of everyone, in many situations. Another consideration in this instance is that that past experience also affects the expectations of the Ambulance Service as an organisation, and therefore the directives that we as individuals are given in terms of our practice.

I would like to be very clear that I would never stand in front of a patient and say 'hey, you need to come to hospital because otherwise I might end up in the Coroner's Court'. We are having a discussion on a forum and I am trying to explain the reasoning behind the the clinical decisions I would make at work and therefore what my, or my colleagues, recommendation would be in the given situation. Fear for my own job lags a long way behind patient welfare.

Building a rapport with any patient is of the utmost importance. We walk into people's lives, often in the time of their greatest crisis, we ask them the most personal of questions, we invade their personal space and then we ask that they trust our judgement and accept our advice. It is fortunate that most people have a pre existing respect for paramedics - we are pretty proud of being voted the 'most trusted profession' by good old Reader's Digest year after year! A rapport can only be built on a basis of respect and communication which goes both ways, and I am proud that I offer bother of those qualities to every patient.

[Ca Plane Pour Moi]

Thanks for this thread. I love the calm, considered and informative replies. It has really helped me in planning for my choices too. Thank you all.

I have no advice I choose to give here as it would not be helpful, but look forward to reading more!

[Lisa]

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

I had an unplanned home birth with my last child.
1. If you should have an unplanned hb, who do you call afterwards (Ambulance or hospital etc)? - We called an ambulance. Midwives & Obs had told me due to my higher BMI and the fact that I'd already had 5 previous births, I was at risk of PPH. This is the only reason we called the ambulance. If that fear hadn't been put in my head, we wouldn't have called at all. I'd never had a PPH before and as it turns out, I never had one.

2. What gets put on the birth form where it asks for attending dr or midwife? -Nothing. She had BBA put on the forms - Born Before Arrival. Nothing was filled out at the hospital at all so DH had to write a stat dec for her birth certificate stating that he had witnessed me give birth to a live baby girl at our home address.

3. Do you have to go to hospital? - No and if I was to do it over again I probably would still have gone just to get us checked over.

4. What items do you need on hand JIC you end up with unplanned birth? -
We just had an extra doona and loads of towels underneath me to catch the mess. I would suggest having something close by to put the placenta in. DH put it in an old salad bowl! Lol.

5. What do you do with the cord (clamping wise)? - the ambulance arrived about 5 mins after the placenta was birthed. On my requested, they waited until the cord stopped pulsating before clamping was done and then dh cut the cord.