Home Birth Risk Factors — Things Which Can Make You Transfer To Hospital
Although homebirth is safe, there are always home birth risk factors which can make you transfer to hospital. To begin with, there are certain conditions which can make certain pregnancies being categorized as high risk. In this kind of situation, you should consult your midwife, and see whether you can still have a homebirth with your high risk condition.
However, there are conditions which are only detectable later on during labor which are genuine home birth risk factors. In this situation, sometimes, a midwife has to transfer you to hospital for further treatment.
Here are the home birth risk factors I am talking about:
A midwife may transfer you to the hospital if you request for it. Usually she offers a transfer if you have a long labor, are in much pain and look very exhausted. In the hospital, she may request an epidural or other pain relief for you so that you can have a break from the pain.
This is a condition where the cord protrudes from the uterus in front of the baby. In this situation, the cord is compressed because of the baby’s head pressing down. Hence the oxygen supply to the baby becomes restricted. This condition is dangerous and requires an emergency cesarian.
In a homebirth, once the condition is detected, your midwife will try to keep the cord from being compressed by the baby’s head while waiting for a transfer to a hospital for an emergency cesarian.
It is worth to note that this situation can arise both in hospital and other out-of-hospital birth facilities and can be fatal in either situation. Your odd of experiencing this home birth risk factor goes up if you fall into these high-risk categories: breech or transverse lie baby, small baby, and polyhydramnios (when you have an excessive of amniotic fluid).
Long second stage of labor (pushing stage)
Lack of progress of second stage of labor can be an indication for homebirth transfer if a midwife has tried everything she could to deliver the baby. At the hospital, an obstetrician may assist by using forceps or vacuum. Alternatively, an emergency c-section might be scheduled if it gets too difficult.
Post-partum hemorrhage is one of the common childbirth risk factors. If post-partum hemorrhage occurs in a homebirth, then a midwife will try to stop it by stimulating the uterus to contract. She can either manually rub the lower stomach to compress the uterus, encourage the baby to suckle or administer a drug which causes the uterus to contract.
In case of hemorrhage in which placenta is not detaching, the same drug can be administered to stimulate contraction of the uterus and placenta detachment.
The resuscitation techniques which are usually used as a first resort at the hospital and can be carried out safely at home are:
- 1. stimulating the baby manually by rubbing the skin vigorously.
- 2. suctioning the nose and mouth to remove mucus found in the baby’s airways.
- 3. giving oxygen using a bag and a mask.
These three techniques usually resolve the situation.
However, if these do not resolve the breathing, then the baby has to be transferred to hospital for further treatment. In worst situation, the baby may have to be hooked up to a ventilator at a hospital.
Cord in baby’s neck (nuchal cord)
Nuchal cord is quite a common home birth risk factor. In most cases, however, the cord is not tight, hence enabling the baby to be born vaginally. A midwife can unloop the cord as the baby’s body is descending, or loosen the cord to let the baby to be born through the loop. In other instance, she may cut the loop as the baby is descending.
However, if the cord is very tight, the baby would not descend. In this situation, a baby may show a distress as indicated by a decrease in the heartbeat. If the distress continues, then the mom has to be transferred to a hospital for a c-section.
If the home treatment does not help, then it’s time to go to hospital for further treatment, either by drug administration via an IV, blood transfusion or even operation in the case of non-detaching placenta. However, it is worth to note that a homebirther is significantly less likely to get a postpartum hemorrhage because of several reason:
– homebirthers are usually not of high-risk category who are more likely to get a post-partum haemorrhage.
– the risk of having a postpartum hemorrhage increases with intervention, such as labor induction and assisted delivery. You will get none of those at home.
– a homebirther and a midwife are more likely to make an extra effort prenatally to minimize or eliminate potential complication/ home birth risk, including preventing hemorrhage from happening. This can be achieved by eating nutritious food, avoiding junk food, smoking, and alcohol, or ensuring to get necessary vitamin and mineral in form of supplements
Baby needs resuscitation
In case of the baby needing resuscitation, all homebirth midwives are required to have a training in newborn resuscitation and they carry their resuscitation equipment all the time in homebirth. Therefore, a midwife will know what to do in this emergency situation and has the means to administer help.
Shoulder dystocia is a condition where the shoulders are still stuck inside the mother after the head is born. This situation is dangerous because the baby cannot breathe with the lung until it’s born. At the same time, it may not get oxygen from the cord because the cord can be compressed in this situation.
Whether this situation arises at home or at a hospital, the treatments are the same, which is using maneouvres to free the shoulder. The most important thing to do when faced with this emergency is changing the mother’s position to give more room for the shoulder to descend. Two good position for this kind of situation are:
- 1. on-all-fours position.
- 2. position where the mom places the knees under her armpits.
These home birth risk factors may sound scary to you. But you could be faced with these risk factors at a hospital too. In fact, some of the intervention at a hospital increases the chance of these risk factors to happen. In addition, for some of the home birth risk factors, a homebirth midwife can offer the same treatment you would have got from a hospital. Finally, while some of the home birth risk requires transfer to hospital , none of them occurs suddenly. Even if you require an emergency c-section, you will get there in time.