What might cause the need for a hospital transfer?
During a planned home birth, you might need to be transported to a hospital for monitoring or treatment. Your health care provider might recommend transfer to a hospital if:
- Labor isn't progressing
- Traces of fecal waste (meconium) appear in your amniotic fluid
- The placenta peels away from the inner wall of your uterus before delivery (placental abruption)
- The umbilical cord drops into your vagina ahead of the baby (umbilical cord prolapse)
- You have vaginal bleeding not associated with bloody show
- You don't deliver the placenta or it's not delivered intact
- Your baby shows signs of distress, such as an abnormal heart rate
Your newborn might also need to be transferred to a hospital if he or she has breathing problems or signs of a medical condition.
What are the possible risks of a planned home birth?
While most pregnant women who choose to have planned home births are at lower risk of complications due to careful screening, planned home births are associated with double to triple the risk of infant death than are planned hospital births. Still, even with that increase, the overall risk of infant death is low.
How do I prepare for a home birth?
You can prepare for a planned home birth by:
- Choosing trained health care providers to assist. It's important to choose a certified nurse-midwife, a certified midwife or a doctor who has a formal relationship with a health care system overseen by your state health department or The Joint Commission. Make sure he or she has easy access to consultation with doctors or specialists at a collaborating hospital. If you're interested in additional physical and emotional support, consider hiring a doula — a professional labor assistant. The American Academy of Pediatrics also recommends having present at least one trained person whose primary responsibility is caring for your newborn.
- Creating a birth plan. Where do you plan to experience labor and delivery? Will you use any specific methods to cope with pain? Do you want a water birth? Will you breast-feed your baby immediately after delivery? What other support people will be present? Discuss the details of your birthing plan with your health care provider. Ask your health care provider what kind of supplies you'll need to provide, such as towels, sheets or other protective coverings for your floor or mattress.
- Preparing for a hospital transfer. Discuss with your health care provider the signs and symptoms that might necessitate going to a hospital and how a hospital transfer will affect your birthing plan. Ideally, your home or other planned birth location is within 15 minutes of a hospital with 24-hour maternity care. Make sure you have access to transportation. Ask your health care provider to make arrangements with a nearby hospital to ensure that you can be promptly transferred and treated, if necessary.
- Choosing a pediatrician. Plan a medical exam for your baby within a few days of birth.
- Arranging for postpartum help. After delivery, you might need help caring for yourself and your new baby. Arrange for family or friends to help. A doula can also provide postpartum support.
What else do I need to know about a planned home birth?
With careful planning, a home birth can be a positive and rewarding experience. Keep in mind, however, that life-threatening problems can occur during labor and delivery without warning. In those cases, the need to transfer you and your baby to a hospital could delay care, which could put your lives at risk. Understanding the risks and benefits of a home birth can help you make an informed decision about how you plan to give birth.
June 20, 2014
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