Back up doc/hosp for home birth?

So... I didn't want to hi-jack anyone's lodge... but I'm wondering about this whole back up plan thing. My midwife did give me a form to fill out a while ago that has spaces for a sort of "in case of transfer birth plan"- including docs and hospitals, etc.

Well, how do you get a back up person, if you're having a home birth with a midwife that doesn't work with anyone?

I have the hospital/midwife where my DD was born, but, I haven't been there for any care since June 2011 (and that was just for a well woman check-up).

They are the most NCB friendly hospital in the area, so I suppose I would choose to go there in any case- but, do I really set stuff up ahead of time??? What do I do? Just call them now and say, I need them just in case?

Advice?

It's not like the hospital would turn you away if you ended up needing a hospital transfer. Aside from that, if you did need a hospital transfer, you would end up with whatever staff is on-call (especially on nights or weekends). So unless you are planning on trying to make sure you get a specific doc/mw JIC you get a transfer, I would just say pic a hospital, write down the mw you know and be done with it. I wouldn't bother to contact the hospital or set anything up. That's just my line of thinking and it's based on my personal experience with hospitals in my area.

In California midwives are legally obligated to either have a backup OB, or get confirmation from their patient that the patient has a backup OB. There are certain conditions that require consultation with an OB, and certain conditions that require transfer to an OB's care, and the midwife needs to know that you can see someone. Also, most insurance companies will only cover hospital maternity services if you are pre-registered, short of an emergency. Most home birth transfers aren't an emergency, so it makes sense to pre-register with your hospital of choice just from a financial/insurance point of view.

In your case, if you'll be paying out-of-pocket for any hospital costs, then I don't suppose pre-registering at the hospital matters. And if you need a consultation with an OB, you'd probably call someone with whom you already have a relationship, the midwife if she's in an OB office. Otherwise you might just be picking a name from the phone book.

Our HBMW had a set relationship with the department head of the hospital she transfers patients to (for VBACs at least). So I never saw an OB or had things set up. I knew I would just get whomever in case of transfer and I was ok with that.

The one thing I wish I'd had done eas had a copy of blood work and maybe prefilled put the admissions paperwork JIC. It was a PITA answering all their admission questions that far into labor. Also they gave me a really hard time about not having blood work records (I didn't do any bloodwork that pregnancy, no need to) and required all this blood be taken when I got there, another PITA. We were questioned numerous times, "so you've had no prenatal care?", even though our MW presented all our other records. :roll:

Even though we didn't do a HB this time, I kept a copy of my health records In my birth bag from 37 weeks on. JIC since our hospital was an hour away. I wish I would have done that with our HB as well. If you HBMW transfers with you she should also have all those records on hand.

I never did have a back up OB or hospital. My midwife has a back up OB for the hospital that is nearly an hour away but if it was an emergency I would have just ended up with who ever was on call at the closest hospital. That's how it usually is with my hospitals though. They don't like home birth transfers.

In case of transfer in Ontario a mom would get who is on call. Our mw's recommend filling out the preregistration papers ahead of time to speed the process. I'm not sure how that would work for you though. Does your midwife have advice or a preference?

I wasn't a home birth, but even at my birth center I had to fill out the preregistration papers at the hospital so they'd be on file in case of transfer. I would have gotten whatever OB was on call, of course, but at least I would have been in their computer and there would have been no record-keeping delay on arrival. They had their pre-registration forms on their website; I didn't have explain why I was filling them out to anyone. If you go to your previous hospital's website, see if they have prereg forms available. If not, just call and request them. I'm sure nobody would bat an eye.

Just one of those "one less thing to worry about" tasks on the to-do list.

I have to fill out a "transfer" plan (required by state law) which articulates how far away the hospital is, directions to get there, etc. For "physician" I just list our family doctor (even though he hasn't seen my preggo once....) But if I were transferred it would be an emergency kind of situation, so I'd go in through the ER anyways......

I also list the ped for the baby (which is the same family doc.)

I don't notify anyone in advance, I just list the folks who have a file on me somewhere in their records. :wink:

I agree with going ahead and filling out pre-registration for the hospital. No reason to tell them why. If you do have to transfer it'll make the process a bit quicker. It's not a long process, but having to do that while in the middle of labor I'd imagine would feel like an eternity!

Joy, the only thing my new office drove me nuts about last appt was insisting on doing all my blood work again including my blood type. Like it's changed somehow. :roll: I know they're just covering their butts, but still annoying!

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Originally Posted by jolly11sd

Our HBMW had a set relationship with the department head of the hospital she transfers patients to (for VBACs at least). So I never saw an OB or had things set up. I knew I would just get whomever in case of transfer and I was ok with that.

The one thing I wish I'd had done eas had a copy of blood work and maybe prefilled put the admissions paperwork JIC. It was a PITA answering all their admission questions that far into labor. Also they gave me a really hard time about not having blood work records (I didn't do any bloodwork that pregnancy, no need to) and required all this blood be taken when I got there, another PITA. We were questioned numerous times, "so you've had no prenatal care?", even though our MW presented all our other records. :roll:

Even though we didn't do a HB this time, I kept a copy of my health records In my birth bag from 37 weeks on. JIC since our hospital was an hour away. I wish I would have done that with our HB as well. If you HBMW transfers with you she should also have all those records on hand.

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I think this is a good point. Each time we go to our midwife, we get a copy of the latest charts and put them in the emergency bag. I think this is important so that they have the information available immediately and we do not have to answer any questions during what will no doubt be a tough time to answer them. More importantly, I was tested for GBS and was negative but in transfers (we were told by the midwife we met at the hospital during our backup meeting) if they do not have the chart saying that I am GBS negative immediately, they start everyone on antibiotics in case. I absolutely do not want that to happen so it is important that they have medical records saying I am negative. Also, we have all of the paperwork saying that we opt out of the eye ointment, blood testing etc. just in case. It sound like, in your case, as long as you have these types of things then you will go wherever you would go and the important things would be taken care of without having to set up an actual "back up" hospital/Midwife etc.