Between five and ten percent of all mothers who have planned a home birth are unable to fulfill their plan based on various complications or situations. It is important both to be prepared for scenarios that may require a transport to the hospital and to have a plan in place to communicate to the hospital staff. Being prepared will help you to feel in control and have her preferences respected even if the situation isn’t as ideal as planned.
Preparing for "plan B"
The main goal of any birthing mother is to have a safe delivery and ultimately a healthy baby. In some situations, a transport to the hospital is due to an emergency situation where there is little time to communicate preferences or even worry about them. However, some transports are done for precautionary measures or personal choice, and you may still have plenty of say over how the birth goes. Maryn Leister, a licensed midwife with Red Rock Midwifery and mother of six, says hospital transports are both rare and often due to emotional issues, not physical problems. “The women choosing homebirth are already low risk and healthy. It seems to me, in my experience, that 'complications' are more likely for first time mamas and often are wound up with psychological or emotional issues,” Leister says.
Some issues that result in a hospital transport are governed by the state, Leister said. “Maternal exhaustion, state regulations, like if the waters are broken for too long, or fetal distress. Hemorrhage is probably less common-- at least for me -- but would be a good reason for transport if bleeding is uncontrollable,” Leister says.
In an effort to prepare her clients for all situations, Leister, like many midwives, gives them a questionnaire. “I have my clients fill out a worksheet together about the birth -- what they envision, what they think their responsibilities are, what they think my responsibility is, what their fears are and if they have thought about the possibility of something 'going wrong,'” Leister says.
Rely on your midwife
Your midwife should act as your advocate even if you are not able to. A midwife or doula will already know your preferences and should be able to be sure they are respected by hospital staff, if at all possible. “Reminding them of what they had desired, but yet not discouraging them from medical care if they need it -- which is likely or else we would have just stayed at home,” Leister says.
Amy Vowles, a home birthing mother of one, didn’t have a formal birth plan as she relied solely on her midwives and she knew they would be there for her in the event that she did have to be transferred to the hospital. “I knew that in the unlikely event of a hospital transfer, they would go with me and continue to be my advocate until my baby was born,” she says. While Amy felt no need to create a formal plan, she did discuss the following scenarios with her midwives.
- Do you want an epidural or induction?
- Do you want constant fetal monitoring?
- Are you okay with IV antibiotics?
- Are you okay with having internal exams?
- Who are you willing to allow in the room?
- Do you want an episiotomy?
- Do you prefer delayed cord clamping?
- Do you want the baby to be placed on your chest immediately after birth?
- When do you want to try nursing your baby?
- Can the baby receive any injections or ointments?
- Can the baby be given formula or pacifiers?
In some situations, your preference may hold little value if anything is deemed medically necessary. Talking with your midwife about these preferences and even writing them down even if they are not applicable to a home birth may save mothers from some frustration if the plans do change.
Worst case scenario
An emergency situation, while rare, will likely blow all planning out the window. A cesarean section delivery is generally performed when the mother or baby are in danger. While the ultimate goal is the safety of the baby, you still have rights in regard to many options. Discuss any concerns you have with your midwife.
The big picture
Having a change in your birthing plan can result in myriad emotions with disappointment and frustration being the
most common. “I have seen mamas choose the hospital when nothing is 'wrong' because they are tired. Those mamas tend to be disappointed in themselves but still feel empowered that they made a decision. When the couple does not want to be there and has to, it can be rough emotionally. Mostly, it's because of the way they get treated in the hospital and often the untrue or dire picture the doctor will paint for them.” Leister says.
Giving birth is an amazing and beautiful experience -- make the most of any situation by focusing on the healthy baby you are about to hold. Being prepared and having a solid plan in place regardless of what happens can help parents cope better emotionally long after the birth is over.