What if... ?

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krazykat's picture
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What if... ?

You had an accidental unassisted VBA2C?

If you knew you were too far along to make the hospital, would you want an ambulance called, or would you let it happen?

Would you go to the hospital afterwards?

Anybody know what happens when you go to the hospital after an accidental home-birth?

What say you wonderful ladies?

cactuswren's picture
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I'm sure what happens depends on the hospital/state/etc. I know I read one story (of just a regular unplanned unassisted, no VBA-anything) where they still made them go in to the hospital and stay under observation for days.

For me it would depend (whether I'd risk such a thing) on the reason for my two previous C-sections. If there was no reason at all to be concerned about my ability to birth vaginally this time around...then maybe, I guess (although if I was truly totally unassisted, I probably would call the ambulance just in case, to be honest) but I definitely would not mess around if there was any reason to think I was at increased risk for anything serious.

But that's just my personal comfort level.

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I would go to the hospital. Mostly because i have NO medical training at all. With no midwife there is a chance you could miss something that is important about your baby's or your health. I feel unassisted births are not a good idea.

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IMHO when birth happens so fast, it's usually because things are going really really well. It can also happen because things are going really really poorly and your body feels that quickly expelling the baby to the outside is the best option. I think, as an educated mom, you would most likely know very quickly which situation you're in and act accordingly. I think it's generally better to stay put somewhere safe & warm & with some basic medical supplies, than to give birth on the side of the road trying to get to a hospital. Assuming you aren't truly alone -- I would call an ambulance in that case -- and if you & baby are just hunky dorry, then I see no reason to bother with an ambulance, just get yourself & baby checked by your respective doctors within a day or two. If you're suddenly seeing stars, that's not right at all (and is, in fact, a signal of dangerously high blood pressure) or if you feel severe or unusual pain, an ambulance should be called. If your placenta doesn't come out after the birth, that requires a trip to the hospital but not necessarily by ambulance, and I'd probably leave baby at home with a loved one.

Sadly, with our society & insurance regulations, I would probably expect that CPS would be called. They would give me a call, I'd explain that baby just came too fast to get anywhere safely, and they'd close our file. I don't believe they would have any legal standing to do anything else. And I certainly wouldn't let the fear of CPS change my decision-making process. My duty is to my baby and my family, and if I've done right by them, I've done right, period.

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I work in maternity. Unplanned unassisted births are more common than most people think. There aren't any sort legal issues following (in Canada). Some people just get quickly checked over (sutured if necessary) and then go home, others stay longer. If all is well, it is up to the mom. As far as it being a VBAC, the main concern it rupture, so if the delivery is done, there isn't reason to be further concerned. Even if you deliver in hospital, there isn't any special VBAC postpartum care.

Personally, I *think* I would call the ambulance if it was a VBAC because it does create a higher risk. In a situation with a low risk mom and pregnancy, I wouldn't. At the hospital, I would just be checked over and then go home.

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If I were to have a *truly* unplanned unassisted birth then I would call an ambulance and go in to the hospital. I have zero medical training and I would have no idea what to look for if something were abnormal. If I were to have a planned unassisted birth (of the variety where I'm not supposed to be planning such things) I would educate myself thoroughly on the matter and then probably call my MW after all was said and done to see what she wanted me to do. I suspect my MW group would tell me to call an ambulance because they're overseen by a high risk OB and that's what they'd be expected to do for insurance purposes.

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I've actually thought about this for this one. I'm planning on laboring at home as long as possible and my mom had really fast labors. I was her first baby and from start to finish was 2 hours, so my mind has ventured into the territory of 'what if it goes that fast'. I would most likely call an ambulance just to be on the safe side, and I would want LO looked over.

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My last birth was unassisted and not planned that way (my MW got there about 15 minutes later....) Oops. It truly was an oops and baby just really came quickly. My MW missed it and my DH missed it (thank goodness my mom and MIL were there to tend to the other three kids and fetch me things like towels!) But I was not a VBAC.....

I just stayed put until my MW arrived and we went from there. All was fine.

My goal for this birth is to have my dh and my mw present. Big goals, eh? Wink

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:lurk:
I know someone who had an unintended unassisted homebirth. Her daughter was crowning as the ambulance pulled up. She did go to the hospital to have her and baby checked over just in case. She was also not a VBAC. No known CPS intervention, but I doubt they would have been called.

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A lot of good thoughts here already. I'm aligned w/ Stacey's post. Allow yourself to be in-tune with your birth, and you'll know if you need to call an ambulance or not. The question of going to hospital after is also a "see what happens" situation. If everything is fine, mom is fine, no excessive bleeding or pain that is making her nervous, and if baby is fine: crying, breathing, nursing, pink and alert... then there's no need to go to the hospital. a visit to the dr's office within the first couple of days will suffice.

If you are having a vba2c and you're concerned about this, I would find out as much as possible about warning signs for complications.

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Thanks ladies! I am not planning to go unassisted, but I AM planning to have DH and our doula help me to stay at home as long as possible. My first c/s was for an infection called chorioamnionitis (my membranes were still intact too). It is pretty rare and not likely to happen again. My 2nd c/s... if I want to be really honest, I think if I had the support of the people around me that I could have birthed him vaginally. I had labored for 48 hours and I was nearly complete with an anterior lip, and I was utterly exhausted. I gave up. He did have a couple of late decels, but I know this can be normal, and my cervix had started to swell. I think if I had changed positions, or if my providers had attempted to manipulate his head (he was posterior and his head asynclitic), that I could have done it, but that is what it is.

I know there is a risk of rupture, and I know that it is an extremely low risk (especially when labor starts and progresses on its own). I know there are risks of other much more common complications that are higher than the risk of rupture. And I am aware of the warning signs.

I'm just not sure if I would call an ambulance or go in afterwards or what. Thanks for all the great thoughts though!!

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"kris_w" wrote:

As far as it being a VBAC, the main concern is rupture, so if the delivery is done, there isn't reason to be further concerned. Even if you deliver in hospital, there isn't any special VBAC postpartum care.

I'm going to respectfully disagree, sort of. There is an increased risk for retained placenta in VBAC moms. But I'll agree that once the *entire* delivery including the placenta, not just the baby, is done, then postpartum care should be the same. Although my HMO's hospital offers an ultrasound to all VBAC moms to check for dihescence but that's probably because they are a research hospital & always participating in a study of some sort.

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I agree. I consider the placenta to be part of the whole birth process. You aren't in the clear until the placenta is passed and you know the uterus is firm and flow within reason (fourth stage).

We don't do any u/s post-partum on VBAC mom's. Research is good though - Hopefully it shows the risk of dehiscence is minimal and decreases some of the outdates practices that seem to be so common.

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I have had 2 VBA2C's, one was a planned homebirth transfered for being tired. Everything was fine just had a really long labor and the last one a planned homebirth unassisted. I loved my homebirth and am planning another one next month. (Baby #5) It was planned though so we did a lot of research and planned on it being home so we had supplies and everything. It can never hurt to know what to do in case of an accidental homebirth but if you were honestly not planning on a homebirth at all and dont know what to do or have not read up on anything I would probably transfer. VBAC's are not as high a risk as some people make them out to be. Yes there is risk but a VBAC mom (after one cesarean) has no difference 0.4% rupture rate, from a first time mom and VBA2C's are only a little bit higher at about a 1.2% rupture rate. (Amniocentesis has a higher risk rate and people do that without thinking twice.) People can rupture even with never having a cesarean before. That being said if you are a VBAC mom there are things that WILL increase your rupture rate such as induction, breaking waters, epidural, black and blue cohosh etc. As a VBAC mom I do not have interventions and things have gone fine and statistically things will go better without interventions.
Since you are planning on going to the hospital its very good to wait till you are in good labor before you go in. If you feel comfortable with it I would wait as long as possible before going in. Do you have a doula? They are a lot of help with support for VBAC's and with knowing when to go in and for support of labor.

Good Luck! You can do it!

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"MeesterMama" wrote:

I have had 2 VBA2C's, one was a planned homebirth transfered for being tired. Everything was fine just had a really long labor and the last one a planned homebirth unassisted. I loved my homebirth and am planning another one next month. (Baby #5) It was planned though so we did a lot of research and planned on it being home so we had supplies and everything. It can never hurt to know what to do in case of an accidental homebirth but if you were honestly not planning on a homebirth at all and dont know what to do or have not read up on anything I would probably transfer. VBAC's are not as high a risk as some people make them out to be. Yes there is risk but a VBAC mom (after one cesarean) has no difference 0.4% rupture rate, from a first time mom and VBA2C's are only a little bit higher at about a 1.2% rupture rate. (Amniocentesis has a higher risk rate and people do that without thinking twice.) People can rupture even with never having a cesarean before. That being said if you are a VBAC mom there are things that WILL increase your rupture rate such as induction, breaking waters, epidural, black and blue cohosh etc. As a VBAC mom I do not have interventions and things have gone fine and statistically things will go better without interventions.
Since you are planning on going to the hospital its very good to wait till you are in good labor before you go in. If you feel comfortable with it I would wait as long as possible before going in. Do you have a doula? They are a lot of help with support for VBAC's and with knowing when to go in and for support of labor.

Good Luck! You can do it!

Katie, thank you for your input. I'd love to read your birth stories if you would like to share Biggrin After my first c/s I became a doula and on a quest for education. With my 2nd I planned a home birth with a midwife that ended in a transfer for another c/s. I gathered every piece of research I could get my hands on during that pregnancy and we did Bradley classes, including a section on emergency childbirth, so I definitely feel like we are covered there. I had a doula last time and will have a different doula this time. I definitely plan to stay away from any sort of intervention that is unnecessary (epidural, induction - even by "natural" methods, etc), and I feel confident in my ability to do so and will have people this time who believe in me.

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If I knew that there was no way to make it to the hospital at that point then I would totally stay at home to have baby. If I thought there was a slight chance of making it then I'd try but be prepared to give birth in the car (just knowing we have a long drive ahead). I'd probably go get checked out after to make sure all the placenta was out and that there were no bleeding or tearing issues. I'd only call an ambulance if there was a true emergency (ie. baby not breathing or issues with my health). I'm more on the side of not worrying that it is a VBAC birth instead of a 3rd vag. birth. Personally I'd feel as safe or safer at home than I would in the hospital anyway if there wasn't any high risk issue beforhand.

We will be staying at home for as long as possible as well this time and will likely have at least an hour drive to our birth place (once I figure that out). We have a lot of stuff left over from our last home birth in the event that baby came at home. DH is thinking of keeping a big tarp and extra towls in our new van JIC.

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I think all pregnant women should have a basic knowledge of what to do if that happens. So many people aren't prepared in the slightest and my general thought is better safe than sorry. Just having a few basic supplies and a little bit of knowledge can mean a totally different outcome imo. Even if you do end up calling an ambulance (assuming you are completely alone). I agree that rupture is a nonissue for a VBA2C. There is very little (if any) change in numbers from a normal to vbac to vba2c birth. I'd really go with how you feel.

As far as CPS goes, when we were reported they told us that there are no laws regarding UC. If things looked/felt fine I'd rest up and go into the doc the next morning. (we had to go to the hospital since we were dealing with cps). Just make sure that your pedi is equipped to do the newborn screenings (any that you choose) and check in with your MW/OB as well within a few days. As for the hospital, when i went i told them I wasn't staying overnight so they ran TONS of tests which drove me nuts because other than him being breech there was very little difference between his birth and any other normal birth. DD's birth was longer even. Anyway, I let them run the tests if it kept us out of the hospital overnight. Also we had EVERY student nurse/doc in the place come see us because it's apparently unheard of here to have a UC. There are some great books out there on emergency childbirth, what to look for etc.

Have you gone into labor on your own or was it some form of induction? I can't remember.

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Jade, I hope you don't mind but I use Trystan's birth story to inspire people all the time. When I say I know someone who had a home birth, unassisted, and had an 11 lb baby .... BREECH, all I get is WOW. You're like a rock star amongst my mommy friends and you don't even know it!

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I would probably go to the hospital, especially since it would have been a first vaginal delivery... if for no other reason than to make sure there were no tears down there, and to check on your uterus. Better to be safe than sorry!

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I had an unplanned unassisted with my second, it was also my second vaginal. Things went so fast I didn't think to call anyone, my husband included. Once he did get home he called an ambulance and I was sure I had tore so I went in for stitches. I live in Montana and there was no grief from anyone, CPS, state, etc, for what happened. I did need to do some extra paperwork to get a birth certificate and prove I wasn't lying about having had the baby.

Looking back I wouldn't have called the ambulance because we were both doing fine, I still would have gone in to be checked and stitched. I did stay 1 night in the hospital because I had lost more blood than is normal with a vaginal, otherwise I would have pushed to go home that day.

Cindy

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Jade, with DD I went into the hospital at 39 weeks with regular, SUPER painful contractions and discovered I had a 104* fever and baby's HR was over 200. We didn't know until after the birth (they kept me for 2 days before c/s and I had an amnio) that is was chorioamnionitis which can have fatal outcomes. I was induced to try to get labor to progress, and now looking back I think I am lucky they even let me try instead of going straight to c/s. But I never made it past 4 cms, and was getting progressively sicker. Sylvia was born infected (but good size) and spent a week in NICU.

With DS I planned a HBAC. I labored for 48 hours, got pushing urges at 9.5 cm with an anterior lip. No induction or anything with him.

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"TiggersMommy" wrote:

Jade, I hope you don't mind but I use Trystan's birth story to inspire people all the time. When I say I know someone who had a home birth, unassisted, and had an 11 lb baby .... BREECH, all I get is WOW. You're like a rock star amongst my mommy friends and you don't even know it!

haha i'm flattered. I love when people ask if dh was freaked out or what he was doing.. "taking pictures." lol I get alot of jaw drops. Smile My aunt had a 9, 11, and 13 lb babies all at home. I'm short 5'2, but weigh about 210 or so.

Ariel, with your ds did you just get too exhausted to push or what? if you were at the pushing stage why the repeat c/s? Not trying to be rude or anything just trying to understand what happened. Also is there any risk of this one having chorioamnionitis?

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"Illiana" wrote:

Ariel, with your ds did you just get too exhausted to push or what? if you were at the pushing stage why the repeat c/s? Not trying to be rude or anything just trying to understand what happened. Also is there any risk of this one having chorioamnionitis?

Noooo, I don't take it as rude at all! In fact, I have struggled with the same question. I'm not sure if it was a necessary repeat c/s. Yes, I was exhausted. We made the decision to transfer after my cervix began to swell. I was at 9 cm when we tried AROM, quickly went to 9.5 with pushing urges, and we noticed thick meconium. It seemed like my MW rushed me to the hospital (she was driving like 60 in a 25 mph zone). I didn't know of any decels at home though until my OB (for this pregnancy) went over my records and noted that there were decels mentioned. The doc on call when we transferred in (we were in a very vbac UN-supportive place) said my white blood cell count was high, but I also know that can happen when your body is in labor. DS had a couple of late decels in the hospital, but I don't know for how long or how serious they really were. At that point I was not of the mind to be able to advocate for myself or my baby, and I felt scared that if something was going on with my baby, then I needed to play by the doc's recommendation. So I'm not sure. If I had felt supported and encouraged and like my body and baby were working properly, I think I could have birthed him, but I really don't know how serious the issues really were Sad

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Have you talked to your MW about it at all after you had time to process what happened? I get the feeling that it was a special case with a difficult call and she made the decision to go in and hospital's always do what the want in the end if you don't have someone to stand up for you. It doesn't seem like it was something that would prevent you from having a HB this time (or UC if that were the case). Meconium is always something of importance to watch for in the fluid but it shouldn't prevent a vag birth unless you're in labor for an excess amount of time.

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"Illiana" wrote:

Have you talked to your MW about it at all after you had time to process what happened? I get the feeling that it was a special case with a difficult call and she made the decision to go in and hospital's always do what the want in the end if you don't have someone to stand up for you. It doesn't seem like it was something that would prevent you from having a HB this time (or UC if that were the case). Meconium is always something of importance to watch for in the fluid but it shouldn't prevent a vag birth unless you're in labor for an excess amount of time.

Yeah I totally agree. It wasn't the meconium in itself, but several little flags that added up I think (not to mention an extremely long labor). I could not ever get my MW to go over what happened with me. I even sent her a letter asking if there was anything in her mind that I could have done different or any contraindication to vbacing/hbacing again. She never responded. Last I heard from her she asked my address to send DS a birthday card and then we never received anything. I know she is very busy, and I have come to peace with the fact that I think we just never had a chance to establish a relationship like she would with a normal client. It definitely was not what I had envisioned from the midwifery model of care. I had transferred to her care at 38.5 weeks. I don't think she ever wanted anything but the best for me, the baby, and my hbac, but the relationship just wasn't there.