How do you treat home birth transfers??

[shortstuff31117]

Just curious if they are treated well at your hospital. I just started at mine, and I havent seen a transfer come in yet, but I've heard a few stories where home birthers came in, for prolonged labor,etc. and the nurses I work with act like it's the worst thing ever. To my knowledge (through research) the LMs in my area are very good and provide excellent prenatal care, know when they really need to transfer etc.

I've seen this at another hospital where I worked during school, and was just wondering if this is the norm. I think it's terrible.

Carrie

[SmilingBluEyes]

It goes two ways, I guess, GardenDove. I think a little respect would go a long way on both sides of the proverbial coin. I have been in this for 10 years and I have seen all kinds of folks. Home birth folks are no more or less difficult as people than the general population. It is the situation they find themselves in that is most difficult for us all to deal with. It goes both ways, like I said.

In a perfect world, everyone would get the birthing experience she most desires and dreams of. I wish this were the case, for all our sakes.

[GardenDove]

Very true Blue eyes. I've certainly met some extremely strident and pushy homebirthers. I agree, respect is a two way street. I think many homebirthers probably feel extremely vulnerable in the hospital setting, feel judged, and some probably deal with that with both barrels.

[SmilingBluEyes]

I am a strong believer people should be able to choose to birth at home---I think it's a great place for folks who are healthy to do so----

they are in control of:

what they wear

what they eat and drink (or not)

who will help them give birth

who will watch/participate

where they give birth (in bed, tub, standing in their living room, in their backyards, wherever)

coping mechanisms without interference from so-called "well meaning" birth attendants, nurses, doctors, etc

absense of (sometimes) needless intervention

Yes, home's a great place to have a baby. Many other nations have no problem with this, I am unsure why we do except that (some) people in the medical community choose to make birth "their domain" and in a way, "lord" over it. It's become almost a power thing I think with some people....and a thing of fear to be controlled medically, as much as possible.

Yes, bad things happen...at home and in the hospital. The problem is, where does RESPONSIBILITY lie when they do? And let's not forget the special interest the insurance and legal industries have in their "stakes" when things indeed, do go wrong.

THIS, is, I believe the crux of some of the problems in the society in which we live and practice (in the USA). Rights versus responsbilities, when actually, these should be concomittant, not a "versus" at all.

Ok enough rambling. Do I make any sense? Hope so...

[Elvish, BSN, DNP, RN, NP]

Totally agree c your entire last post, Deb.

[GardenDove]

Not every OB nurse is as open minded as you, Blue eyes. I float to OB and I hear many judgemental statements at the nurses station about many of the parents. I've heard trash-talking about a local midwife who I've heard is quite good.

This midwife told me that she has helped some women who were higher risk because they were then going to go it alone. Some lay midwives have done that because the alternative is an even riskier situation. Then, when she accompanied them to the hospital, she ended up harshly judged. Yet, she had originally recommended that the woman seek a hospital birth. The nursing staff was extremely judgemental to her.

[SmilingBluEyes]

I like to think I am a fairly good representative of many OB nurses. I know most I work with are kinder than that. Although I know I am more open-minded than some.

[bagladyrn, RN]

Garden Dove - I think perhaps you are judging a little harshly yourself. Try for a moment to put yourself in the place of some of your OB coworkers. When the woman being transferred arrives, she is obviously already in a higher risk category, needing interventions, very likely needing them rapidly after arriving (as I'm assuming she would not have come in otherwise). The nurses may have minimal information on her medical background, certainly do not have the knowlege that this "high risk" woman had been taken on by the midwife only to "prevent a worse alternative". The nurses are stressed by the knowlege they do have that a negative outcome for mother or baby may be the result of them not taking the actions the mother/midwife are objecting to. Add to that as SBE said, the hostility being directed toward them simply for trying to do their best to help a mother/baby in a crisis situation .

As a personal note, I do get a little hurt by this assumption that we OB nurses are on some kind of power trip and get off on bullying pregnant women into doing unnecessary hurtful things and ruining their birth experience. There's nothing I find more rewarding and enjoyable than an unmedicated, well informed mother having exactly the kind of delivery she wants. When things can't be that way, I do my best to adapt as much as possible of the procedures to accomodate her original plans.

[SmilingBluEyes]

I feel just as you do, Baglady. I feel a bit defensive myself; I consider myself to be a really good, compassionate and caring nurse.

As I said, a little respect on all "sides" would sure be nice.

[33-weeker]

Many hospital staff have bad attitudes toward home birth transfers. Some have good or at least neutral attitudes.

Some home birth families and or midwives have bad attitudes - partly due to the prevailing negative attitudes they know they will likely face with a transfer combined with their strong feelings of wanting to birth with as little intervention as possible. Some have appreciative attitudes and are cooperative.

Any combination is possible depending on who is working and who transfers from home.

The main reasons for the bad attitudes of the staff are lack of education and a broadened experience where birth is concerned, institutional indoctrination that hospital birth is best and homebirth unsafe (which statistics do NOT support for most women), and the fact that hospital staff only see the few homebirths that go badly - NOT the thousands upon thousands of homebirths that go well.

I was fast being indoctrinated into the 'hospital is best' thinking right out of school, but luckily I read and studied and broke free from that mindset over a period of years. I had all my kids at home with a midwife.

The bottom line is that we need to be professional despite our personal feelings. I'm polite to the social inductions (although I don't lie to them about why their kid is in NICU under oxygen) even though I don't agree with them putting themselves and their babies at risk like that without medical justification.

We are polite to that rude drug addict mom; we educate ourselves about the foreign mom and her odd ways - don't the hombirth transfers we get, who simply want the best for their babies and themselves, deserve at least as much?

[SmilingBluEyes]

No one debates they do deserve the best. ALL our patients do.

[motherwise]

I have lots of opinions about this so please bare with me.

First I used to be a Licensed Midwife in Washington state. The laws for obtaining your license are very extensive and include two years of prerequistes as well as three years of midwifery. I had over 1500 hours of clinicals and had to deliver 100 babies before graduating.

My clients were always well educated regarding the why's and how's of a transport and the fact that when we transported in it was because we needed help. I had them preregister at the hospital (just in case). I always emphasized the need to work with the hospital staff and that it was important to be respectful.

Now...I have had some very smooth transports where the hospital staff was respectful of the parents decision to choose out of hospital birth and worked with me and the patients to make it the best experience possible. However I had more than one occasion where the staff spoke bad about me, my abilities and it seems that they tried to prove me wrong every step of the way.

One experience was very personal. This was my sister's birth. She actually planned a hospital birth but she was laboring at home during the early part. Early that day when I checked her she was 4 cm. Couple of hours later she sponateously ruptured and labor picked up quickly. I called the hospital to let them know of our arrival, her membrane status and early exam. When we got to the hospital the nurse was very curt, performed at sterile speculum exam (while my sister was writhing in pain), claimed she was not ruptured and that she was only 2 cm dilated. She never called the doctor, didn't put her on the monitor and clearly didn't listen to her patient (can you say transition!). She came in with discharge papers (!) at which point my sister said "I need to push" and crowned. I talked a very scared nurse through her first delivery.

I had another case where I had transported in after only have the patient in my care for 4 hours. All exams, vs and fht's were wnl however this patient made me uncomfortable (yes I do believe in intuition). Her water broke at 5 cm, thin mec and fht up to the 200's. Immediately transported to the hospital. Once there she was complete, fht's on monitor looked fine. The doctor and nurses commented on my exam (as though women don't sometimes progress quickly especially after SROM) and proceeded to tell me the baby looked fine. She started to push at which time I made a comment to the doctor that she was going to deliver quickly. She gave me a dirty look and turned away. At just that time the woman pushed and baby fell into the garbage. Baby, who looked great on their monitor (end up being mom) was limp, white, not breathing and had a heart rate in the 40's. She was successfully resuscitated and is a healthy happy girl today.

The staff spoke poorly of me and my abilities even though I had made a quick decision to transport and they had dropped the baby and hadn't picked up there was a problem with baby. If I hadn't transported when I did where an entire NICU team worked on this kiddo she may not have made it.

These kind of attitudes make it difficult for midwives when they transport in and unfortunately results in transport decisions sometimes being delayed not to mention increase the likelihood of lawsuits.

Now on the flip side I am an RN now working in L & D ( I am working on my nurse midwifery degree). I am appalled by what I have witnessed as irresponsible and down right dangerous actions by lay midwives in our area. Lay meaning that they have had no formal training. Women have come in after laboring for days or pushing for many hours including VBACS. The attitude of some of these midwives in pushy and arrogant and frankly I can see why the attitudes in the hospital start.

What I think needs to happen is both midwives and nurses need to work at understanding each other. Maybe the L & D manager could schedule a meeting with the midwife to go over hospital protocols regarding monitor, GBS status, pain relief, c-secs, etc as well as what would be helpful during a transport situation. And the midwife needs to work with the staff to work towards the ultimate goal which is healthy happy mom and baby.

[VegRN]

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.

So, I don't work in L&D so maybe my view is a bit scewed but maybe it is more similar to the moms that wanted homebirth since I have no clue what happens in L&D units.

I meant that maybe the Midwife and Doula or whatever were just trying to follow what the mom wanted. I am under the impression that the moms write out some type of Birth plan and the Midwife and other players try to follow it. Maybe the mom just wanted to give her birth more time to maybe happen "naturally" while being monitered by hospital staff. Maybe she didn't want the pitocin, c-section or whatever, just yet. Maybe she just wants some more time to try "naturally" and the Midwife is just trying to advocate for what mom wants?

I don't work in L&D so I don't know what types of issues these moms come in with. Maybe it is life threatening to the baby or maybe the birth just isn't progressing. I just think that sometimes maybe the midwife/doula/etc are advocating for what the mom wants and the L&D staff interprets it as the midwife trying to be controlling.

Does this help explain what I was trying to say?