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If I have to transfer to the hospital....

Last post 09-30-2009 5:00 PM by marlenecpm. 11 replies.
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  • 09-11-2009 3:30 PM

    If I have to transfer to the hospital....

    Hello,

    If I transfer to the hospital what should I include on my Birth Preferences, I must say here that I never know what to call it "Birth Preferences" makes me feel like the hospital staff will assume everything is optional whereas "Birth Plan" may make the staff assume I am unwilling to waiver should a true emergency arise.

    Anyway, here is what I have included thus far (and please feel free to assist with wording)

    Intermittent monitoring with a fetoscope

    Hydration and food intake according to thirst/hunger and without limit

    Natural techniques will be used for pain relief

    Setting the environment: dim lighting, comfortable room temperature, music, my own clothing for the labor and birth, use of water (labor pool and or shower), use of massage tools and birth ball.

    I will push according to my body's signals

    I would rather risk a tear than have an episiotomy

    EMERGENCY CESAREAN SECTION

    I would like a second opinion and to be fully informed of what is happening and why at all times.

    My husband will be present at all times. He will be taking pictures and video recording the delivery.

    The baby and I will be together for recovery.

    BABY CARE

    The umbilical cord should remain uncut unless authorized by my husband or myself.

    The baby should be put on my abdomen immediately following birth. *In the case of a cesarean section: Dustin will hold the baby and placenta following extraction.

    DO NOT suction the baby, rather have my husband or myself lean it forward and the fluid will come out with the help of gravity, or lay the baby across my abdomen and I will wipe up the fluid that comes out.

    These procedures will NOT be administered following birth:

    Vitamin K shot, Hep B Vaccine (the pediatrician will do this), eye ointment, bath, and circumcision.

    NO PACIFIERS, BOTTLES, OR SUPPLEMENTAL FEEDING. 

    Am I forgetting anything that a hospital routinely does that is unnecessary?

    Thank you for reading and responding.

    Jennifer V.

  • 09-11-2009 4:16 PM In reply to

    Re: If I have to transfer to the hospital....

     I do think birth plans are a great idea, and i had one for my homebirth, which went entirely to plan, BUT i think it's useful to consider the possible reasons for transfer when writing the plan in case of transfer.

    You might transfer for additional pain relief - if you have that you will need to have the addition monitoring because the baby is compromised by the drugs.  And of course "natural pain relief" becomes irrelevant in that situaton too.

    If you have transferred because of an emergency they will get the baby out, fast.  They may or may not have time to read your plan and even if they read it they will still do whatever they see fit to get the baby out healthy, whatever your preferences were.  For example if baby is severely distressed there may be a lot of people in the room, and they will ask your husband to keep out of the way while they get the baby out, whether by vaginal birth (when they will tell you to psuh hard and when you don't necessarily need to to hasten delivery) or by c-section.  If the baby has been distressed in labour there will be a paed there too, and if baby is slow to start they will absolutely begin resusitative efforts, including suctioning and cutting the cord to get the baby to the machines right away, whatever the plan requests.

    Basically if you get the birth you want you'll be at home, where you wanted to be, but if you transfer it will be for a serious reason, serious enough that a lot of the things you'd planned will be irrelevant or innapropriate.

    I think for my transfer plan, which i kept incredibly short to up the chance that they might actually read it, i said i wanted DD to have skin-to-skin with one of us following birth if she was well enough to do so, that i wanted no pacifiers or artificial teats of any kind without our consent, and that i wanted one of us to be consulted before any vaccinations were given.  I didn't include circumcision because no one would ever do that in the UK, but if i were in the US i would.

    So, my advice would be to imagine if everything goes right (very likely) you will be at home, having the beautiful birth you planned.  Ask yourself if something goes really wrong what are the bare bones of what you want?  It's very unlikely that you'll need to transfer, and if you do it may be a life-or-death situation, so what are the things that matter so much (like the Hep B - in a forceps or c-section, when forceps are often used the vitamin K might debatably be a good idea, depending on if and how much the baby is bruised) that you want them adhered to even in a situation so serious?

    It's wonderful that you're looking at this.  I don't know how far along you are but i finally got around to writing the "Plan B" plan for transfer at 40+10 and i had DD the very next day Smile

    Bec

    Me 32, DH 41, DD 2006, DD 2010, DS 2013
  • 09-11-2009 5:27 PM In reply to

    Re: If I have to transfer to the hospital....

    I agree, keep it short and sweet.

    They probably wont use a fetoscope. 

    They may have to suction the baby in the event of an emergency that would necessitate hospital transfer.

    One more thing, you may mention or ask them verbally not to do a ton of internal exams on you or touch you more than is necessary.

    You may also mention or tell them not to pull the baby out after the head is out if FHT are fine.

    one last thing off topic... are you sure you want the Hep B vaccine for a newborn at all? It is the most unnecessary of all vaccines given to babies. Just FYI

  • 09-11-2009 6:48 PM In reply to

    Re: If I have to transfer to the hospital....

    Jennifer,

     Is the HEP B vaccine necessary later in life? Where did you get your information?

    Thank you

    Jennifer V

  • 09-12-2009 5:57 AM In reply to

    Re: If I have to transfer to the hospital....

    I think you read her "plan" incorrectly.  It was under the "what NOT to do" list.

    Intermittent monitoring with a fetoscope:  That's just not going to happen. They probably don't even have one and if you bring your own, they will not use it or balk at using it and may make the rest of a possible stay in the hospital worse.

    If you are planning a homebirth with an attendant, a transport would be happening because the birth attendant would feel that the situation warranted it, that it was beyond that person's abilities or scope ... in other words a true situation which required the technology of the hospital. Although it's possible to salvage (for lack of a better word) or preserve as much as your original preferences were at home, most of the time it is not.  A woman would be entering the hospital for the type of care that only they could give there.

    I think it's a great idea to give preferences on how you would like to be treated and that any one of us needing a hospital for whatever reason (my husband's heart condition, for ex.) should state these things, there are some areas where it's not possible, not feasible for someone to get "home care" in the hospital in a twisty situation let alone an emergent situation.

    The other thing to keep in mind is that the way the way things are worded (and I'm trying to pick my words very carefully and specifically here ... but it may not work!) may determine how you are perceived as a family and how you are treated.  This may not seem fair and we'd expect the hospital to treat everyone the same, but the reality is that hospitals with as much machinery and "stuff" that they have, are run by humans and when you enter their turf, they don't want to be told what to do.  When you word things like "Don't do this, do it this way", they may circle the wagons and get quite defensive.  For ex., the portion you wrote about suctioning.  Again, in a twisty, complicated or emergency situation, they may not be able to lay the baby forward to remove mucus; they may need to do things fast.  If you kind of turn it around and think about one of the hospital staff coming into your home during your labor and instructing you on how to do things or jumping up to intervene when everything is going well, you've got kind of the same thing going on.  Does that make sense?

    Keep the plan short and sweet.  You may not even want a plan (preference list)  at all!  You or your husband can make requests right there w/o a written plan.  Some would disagree with me and I know it varies from place to place in the US.  In our local hospital, for ex., when a woman transports into the hospital, they tell her what they feel needs to be done (unless it's a true capital E bold faced emergency) and then ask her what her preferences are or if she needs time to discuss whatever with her husband/partner.  You may want to find out from your midwife or doctor what the deal is at the hospital they transport to and then go from there. 

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 09-12-2009 8:57 AM In reply to

    Re: If I have to transfer to the hospital....

     I also agree Hep B  vaccine is unnecessary.  From your birth plan, it seems you want your Pediatrician to give this vaccine.  Hep B is contracted through unprotected sex, iv drug use or exposure to blood (usually as a health care provider).  Certainly your baby is at low risk for this.  There is some belief that if your baby/child is in childcare, they could be exposed to a child who has contracted from a parent with the above risk factors.  About the transfer birth plan...I'll tell it like it is.  I was a nurse for 10 years and never once did I see a positive response to a birth plan.  The woman/family ALWAYS received worse care.  I think you should rethink this.  It was almost as if the doc/nurse/whoever wanted to prove the woman wrong.  I know it's offensive to women on this forum, but the common response to a birth plan is, "Get the OR (operating room) ready," and more times than not, they were correct (self-fulfilling prophecy).  I guess I never understood the reason for a written plan.  What happened to just talking with each other?  I think people are more open to polite discussion, than a written, "legal-like" document.  But, again, like other posters have said, if you are being transferred, it's not with the hope of a perfect birth--if you were going to have a perfect birth, you'd be at home.  If you are going to the hospital, it is for an intervention not possible at home.  Joyce.

  • 09-12-2009 11:11 AM In reply to

    Re: If I have to transfer to the hospital....

    Yes, I think it may be a good idea to write a birth plan and give it to your husband to keep in his pocket. if you end up in the ER, have him take it out to refresh his memory and verbally request things from them.

    thinking back to my own birth which was a transfer, they were already hostile towards us for coming in from a homebirth, I can't imagine if we had presented them with a list of written requests. Maybe they would have been receptive, but I doubt it. I had to remind them like 50 times (while I was pushing) not to touch my perineum and let me do it myself, so I don't think a piece of paper would have much more of a difference. But do get your husband to take it along. It's harder to remember things in an emergency.

  • 09-12-2009 3:53 PM In reply to

    Re: If I have to transfer to the hospital....

     

    EMERGENCY CESAREAN SECTION (THINK!  Emergency does not equal "We have lots of time to discuss matters."

    I would like a second opinion and to be fully informed of what is happening and why at all times. Good idea for anyone.

    My husband will be present at all times. He will be taking pictures and video recording the delivery.  Probably not gonna happen.  Most hospitals are really spooked by having pictures and recordings of any "procedures" and surgery is a big time "procedure".  Again, in am emergency situation, there isn't time for someone to be using equipment and again, in an emergency situation, mother and/or baby may not be in the best of shape.  Most hospitals don't even allow filming of the actual birth any more!  (Sad but true.)

    The baby and I will be together for recovery Good idea and I would think available at most hospitals.  However, if you decide on a written plan, perhaps using "I would like my baby and my husband to be with me in the recovery room" rather than using what can be perceived as "dictatorial language".  Remember: You're on their turf and they can make things really, really uncomfortable if you and they are hostile..

    BABY CARE

    The umbilical cord should remain uncut unless authorized by my husband or myself.  Please think about that word "authorized".  Again, in a cesarean or emergency situation, the cord is cut quickly so they can work on baby and/or mother.

    The baby should be put on my abdomen immediately following birth. *In the case of a cesarean section: Dustin will hold the baby and placenta following extraction.  Not gonna happen in a cesarean.  Think:  If this is a cesarean, there's going to be a bunch of people in a small OR.  There's going to be a surgeon, an assistant to the surgeon, a nurse anesthetist or anesthesiologist and possibly and assistant to that person, at least 3 or 4 nurses, AND someone on standby from the NICU.  A mother is undergoing major abdominal surgery.  There isn't room nor time for a loved one to be standing with the surgical team, holding a baby and a placenta ... and seeing their wife "open".  Again, baby will need to go over to the warmer to be checked out to determine if s/he's OK and if s/he needs further intervention.  This isn't like a planned cesarean you're talking about.  You're talking, "I planned a homebirth which turned twisty and complicated and I need medical intervention" ... or you wouldn't be there!

    Have you taken a tour of the hospital that would be accepting you for transport?  Have you asked very specific questions on the tour?

    Having a written plan folded up in dad's pocket may work ... in a hospital birth.  If you have a birth attendant (as in you are not planning an unassisted birth), it may be wise to sit down with your midwife or homebirth doctor and ask what the climate is at the local hospital, if they're going in with you, what records you will be carrying in with you, if that person can advocate for you in an emergency situation.

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 09-14-2009 1:01 AM In reply to

    Re: If I have to transfer to the hospital....

    o/t again but I am so sad to read of the general hostility towards birth plans in America (not that you guys feel it, but what was said about the view of other staff being "get the OR ready").  In the UK EVERY woman is encouraged to think about and write a birth plan by their antenatal midwives, some do and some don't.  In lots of hospitals if you have a plan and the birth is wildly different to it, they even send the counsellor to your bedside in the next few days to see if you need to debrief.  That's not widespread, but not unknown either.

    And though the plans of course aren't always read or followed depending on the specific staff or the specific birth, the system accepts that women are human beings who may have preferences about their lives and experiences.  The plans which result in hostility or judgement are ones which are 12 pages long, or say things like "your aura will be smudged by our white witch at the delivery room door, if you don't allow this to happen we will request that you do not enter the room" or "I do not consent to physical assessment, please do not touch me, i will consider contravention of this request assault and i may request the police be called" - basically things which make the staffs' jobs very hard.  A woman showing up saying she wants to do without drugs if possible and not have the cord cut right away would be treated just like anyone else.

    I found a written plan very useful as a discussion point with my midwives who didn't have time to sit and get to know me for hours and know my preferences (one of the reasons we're going with an independant MW next time), and even in the middle of labour - i had put on my plan, knowing with my blonde hair and papery skin i mght tear, that i didn't want to deliver on my back.  In the event i lay down for a VE, DD's head had crowned, the midwives had a flurry of activity to prepare for my suddenly imminent baby and one reminded me of my preference and asked if i wanted help to move into another position, which she had remembered from my plan.  In the event another contraction was coming on, i decided not to move, delivered in that next contraction, and recieved a 2nd degree tear which thankfully healed unstitched (again, my choice), but i felt the midwife reminding me of the plan when i was completely lost to labour made a real difference to how i felt about the tear - i felt i had had a CHOICE in that moment.  She helped me just by reminding me of what i had wanted, and i accepted before it happened that i was more likely to tear.  If a careprovider has time to know a woman well, to know how she feels about her labour beforhand and the things she wants, feels important or doesn't want then of COURSE a birth plan is very unnecessary.  But when a woman and midwife might be meeting for the first time on labour-day a birth plan can be seen as more "this is who i am" than "this is what i want" - some plans say things like "i want an epidural as soon as possible" "i would prefer a c-section to a long labour or an assisted birth" and so on, it's not only those who are against intervention who write them.  At least it's a place to start communicating, no?

    Me 32, DH 41, DD 2006, DD 2010, DS 2013
  • 09-14-2009 5:52 AM In reply to

    Re: If I have to transfer to the hospital....

    sigh! It's so difficult because each hospital is different and attitudes of the staff can vary widely.  I do hope, however, that there is not "general hostility towards birth plans in America".  I know there isn't in my neck of the woods, except for those that are 12 pages long as described above.  That's why I was trying to get Jennifer V to see that some of the wording she was using was going to not only be off-puttnig but was not very realistic in an emergency situation.

    This is not a very good "patriotic day" for me.  I feel so sad that Americans are seen in such a poor light.Sad[:'(]Embarrassed

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 09-15-2009 12:22 AM In reply to

    Re: If I have to transfer to the hospital....

    (((((HUGS))))) Susan, don't despair.  It doesn't come across that all Americans don't like them, more that i see in America some are more likely to be suspicious of them.  It's the same with circumcision - it's seen as something americans do needlessly to newborns but i know LOTS of Americans working tirelessly and thanklessly to protect little boys from this cultural norm, and the cultural norm will change eventually because of their efforts.

    Your comments are very wise indeed - even in the UK where birth plans are wisely accepted as normal you still do better with polite considerate language and rational requests.  Also you do hear some mums saying "oh don't boher planning, i had a plan and i ended up having a c-section anyway, better to keep an open mind and not be disappointed" which to me is ridiculous since i didn't decide what i wanted for the birth plan, i wrote down what i already knew.  Not saying i wanted a homebirth wouldn't have stopped me wanting one, but just as in the US your healthcare system has you (the broad you, not the personal one!) seeking "the best" care but unfortunately being told "the best" is surgical or very medicalised when it comes to birth, so in the UK culture following decades of NHS care people have a "why try when you'll be disappointed" viewpoint because we have all accepted that healthcare isn't something that we can rely on very concretely, since the NHS has always needed more money, people and resources than it has.

    I think the main reason there is such comparison and contrast for me is that i see America and the UK as 2 cultures which sprang from the same well and it's interesting and sometimes challenging to see the differences all these years later.  There is much that is enviable about America too, after all it's produced you! Wink

    Me 32, DH 41, DD 2006, DD 2010, DS 2013
  • 09-30-2009 5:00 PM In reply to

    Re: If I have to transfer to the hospital....

     The only way for baby to get HepB is from mama or hosp. staff. Both are very unlikely. It is a blood born pathogen. The most common way to get Hep B is to share dirty needles with, or get bitten by someone with it (as sometimes happens in institutional living/working settings) If and when, these lifestyle choices crop up, your kid can choose to get it or not. Most all health care workers and prison guards have had their Hep B shots. I would never subject my baby to that (unless of course I had the disease myself)

     I agree that it should be short and to the point. Choose your battles carefully! One thing I would add is, if for any reason,  you and your baby must be separated, dad stays with baby AT ALL TIMES, and your doula, mother. midwife, whomever else you have there with you, stays with you, at all times. For instance, if you need a C/S dad follows baby to nursery while another support person joins you in the recovery room (not wait until your get to your pp rm!)

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