How do you treat home birth transfers??

tntrn, ASN, RN · Jan 24, 2007

Where I live in WA, I don't think I've ever had a home birth transfer come in and I've been here 20 years.

But No CA in the 70's and 80's, we had them all the time and mostly I'd say it was how they and their Lay midwives treated the staff that was at issue. They start telling us what we could and couldn't do: such basics as No IV or No Pit. You did all that at home and how did that work for you? The answer: it didn't and that's why you came here, so please let us try to do what might help you have this baby.

I'm sure the staff where you are treats those patients like all the rest: confidently, competently and professionally.

Elvish, BSN, DNP, RN, NP · Jan 24, 2007

I think it depends on the situation. As tntrn said, most of my coworkers & I treat everybody the same regardless of, well, anything.

One lady I remember came in after an unsuccessful homebirth after pushing for 5 hours. Big surprise -- her baby weighed something like 11 pounds & wasn't fitting through her pelvis built for a 7-pounder. What I remember most was the way she treated the staff. Prima donna and very disrespectful.

I realize she is the exception, and she no doubt had some issues to resolve about her birth experience. I have no problem at all c homebirths. You just have to have a midwife who knows when to transfer, and a laboring woman willing to trust her midwife. And a healthy, low-risk pregnancy.

SmilingBluEyes · Jan 24, 2007

I will try to give you insight from both "sides" if you will, Carrie.

First off, personally, as an OB nurse in the hospital setting, I try very hard to understand these ladies and their loved ones are not coming into my care by choice and I am ever-mindful and respectful of that. I know these families are upset and often very intimidated by the hospital environment and I try to remember that as I care for them. I also know far too many undesireable interventions occur in hospital birthing and this is often why they avoid seeking our care in the first place. It's a very unhappy situation for them when they come to the hospital.

But you have to remember: success and gaining trust is a two-way street and this would ALSO depend on the attitude of the home birthing family. I have seen quite a few come in who were VERY, VERY hostile and angry (understandably) about the loss of the birthing experience they hoped and longed for. I have seen them and their midwives come in and be out and out rude and disrespectful of staff from the get-go, before we even attempt to touch them. I have seen others whom I could win over with respectful treatment not only of them---- but their midwives, as they know them best. I always include their midwives, doulas and family members in the plan of care when they come in. All in all, like with anything, we have had some very bad and good experiences with home-birthers who came in to deliver----they vary in the spectrum.

I will say, I am only a fallible human. For me, it is exceedingly hard to deal with hostile folks who won't let us care for them according to hospital and obstetric policies set (not by our choices). It's very difficult and unpleasant to deal with folks who fight you tooth and nail all along the way, while you do your best to care for them with respect and kindness. You have a very short time to gain trust and get to know them, as you know NOTHING about them when they hit your door for (often emergent) care.......

Yes, once they hit our doors, we are all left with few choices, they as well as us, so the situation is challenging at best at the outset. THIS may be why you see your coworkers "acting as if it's the worst thing ever".......no nurse wants to upset and/or antagonize patients in his/her care. But when nurses and doctors are hit with open and frank hostility from the minute they meet these families and their caregivers, it's very difficult to surmount the personal feelings that arise within them to become defensive. I do my best, that much I can guarantee. And it's hard to fail at gaining trust and pleasing the people I care for, no matter who they may be.

As always, Carrie, there is more than one side to the story.......and as you gain experience, you will see that.

VegRN · Jan 24, 2007

But No CA in the 70's and 80's, we had them all the time and mostly I'd say it was how they and their Lay midwives treated the staff that was at issue. They start telling us what we could and couldn't do: such basics as No IV or No Pit.

Maybe the midwife was advocating for the mom, not for herself?

I can imagine that it would be quite a disappointment not being able to have the birth that you had planned and hoped for too.

tntrn, ASN, RN · Jan 24, 2007

VegRN:

I'm not sure I understand your post. Could you please explain?

SmilingBluEyes · Jan 24, 2007

I think, Carrie, it would be very useful to try to persuade the doctors with whom you work to communicate with the homebirth midwife community about their being welcome when they come, but also knowing what to expect, regarding care and the policies (like fetal heart monitoring or saline lock placements, etc) ahead of time, when and if they must have the services of the hospital. I think a little communication between practioners would help this a LOT. The staff have very little say-so about how these things go, and like I said, are nevertheless, bound by set policies, to do certain things in treating these patients. It's a two-way street.

SmilingBluEyes · Jan 24, 2007

Also, Carrie, having read some of your posts, I see you are an advocate of natural childbirthing (or I get that feeling). Do they have midwife-run birthing centers near you? If so, you might want to check out working with these midwives in more natural and low-key settings than those of your L/D unit. Most L/D Units are VERY medicalized, like you have said, and this is a shame, but a fact. Maybe you would feel more comfortable working with midwives in a more low-key, homelike setting? I know many times, I surely would. I love the rare occasion when I get a naturally-laboring family into my care and miss it so much.

shortstuff31117 · Jan 25, 2007

I'm in WA too! Do you not have a lot of home birth midwives where you are? We have quite a few in my area...

shortstuff31117 · Jan 25, 2007

Thanks for the idea...We do have a birth center just north of us...I don't know how that works though. I would love to be a midwife assistant or something like that...its just that I'm supporting my family right now so this is how it is

GardenDove · Jan 25, 2007

I've heard from the home birth community that they at time encounter hostility from some staff when they transfer. Very unfortunate, but probably unavoidable. I had my 6 at home and am thankful I never had to deal with hospital personnel and their hostility. I would never want to give birth at my hospital, as much as I like our OB nurses as people.

SmilingBluEyes · Jan 25, 2007

It might not hurt to ask these midwives if they could use an RN assistant, Carrie. It sounds like you are not happy where you work. Life is short, very short-----find what works for you.