I’ve learned a lot about childbirth over the years. I have nine children who were born in various situations including planned home births, planned hospital births, and even one born in the car! Throughout all of these situations, the one thing I have learned to be true no matter what is that God is in control. For two of the births, circumstances outside of my control led me to change my plans at the last minute, and became hospital births, despite my envisioning beautiful home birth experiences for both. Still, if I were to find out I was pregnant tomorrow, I would begin again planning for a baby to come at home, because I know from not only vast experience, but also from massive amounts of research, that home birth is the safest option for my baby in the event of a normal healthy pregnancy.
What happens, though, in the case where everything doesn’t go according to plan and a transfer has to happen? Let me share my story with you as I share the steps that happen as you transfer from home to hospital, and from one kind of care to a very different kind of care.
The vast number of people, if asked, would probably agree that good prenatal care is extraordinarily important when it comes to supporting a woman through a healthy pregnancy. Certain things are done to ensure that the baby is growing and healthy, and that the woman is caring for herself and her baby in ways that will ensure she goes into delivery with the optimum chance for a good outcome. I began my journey through prenatal care very early in my pregnancy. As a matter of fact, my midwife and I were jogging together when I told her before I told anyone else that I thought I might be pregnant. It didn’t take her long to switch from fellow jogger to midwife, and either that run or the next, she began to ask me questions about how I was eating, how our level of exercise made me feel, and how my thyroid was adjusting to the hormonal changes. Throughout my prenatal care, there were a couple of questions about my health that weren’t necessarily red flags, but just bumps in the road that we cruised over together. My platelets dropped, but leveled off with some vitamin B-12 therapy, and we were on our way to what we all assumed would be my third home birth in a row. My prenatal care was stellar; probably some of the best in the country. My appointments lasted an hour, and during that time I was encouraged to talk about everything from how my pregnancy was affecting me emotionally to how I was feeling physically, and what I was eating to make that better or maintain it. Had I started this journey with an OB-GYN, my appointments would have been scheduled at 15 minute intervals with hundreds of other women in a clinical setting. These appointments would have cost me anywhere from $100.00 – $200.00 a piece if they were priced out, and my doctor wouldn’t have been able to take the time to get to know me personally, even if he really wanted to.
The weeks flew by, and our jogging turned to walking, and before you know it, it was almost time for the baby. I felt so ready to have my baby anytime, that at the beginning of September, we started talking about my dates possibly being off. My midwife, in her wisdom, just kept reminding me that my ultrasound supported my original due date near the end of October, and that God’s timing was best, and exactly what we wanted. I begin to rest in that fact, and managed to keep my spirits high in spite of the long last trimester. Praying was a big part of my life at that point, and I asked everyone I knew was a prayer warrior to keep me in their prayers as the weeks unfolded. A small unease that I’d like to think was planted there by the Holy Spirit began to nag in my mind as I began to think of my birth, and I began to envision how it might go if I needed to transfer for any reason. I prayed for grace should that be the case, but continued to plan and envision my perfect home birth.
Finally the time came to have my son. I was more than ready! I had called my midwife several times in the preceding weeks, thinking that it just might be the moment. Then on October 30, at around 9:00 in the evening, I lay down to go to sleep and felt and heard a small pop. I knew immediately that my water had broken. I managed to make it to the bathroom, only to discover that the waters were full of meconium. It was very dark and ominous looking, and I knew it to be a bad sign. I contacted my midwife, and she was there in no time. We decided to check my cervix for progression of labor, and discovered I was barely dilated. I was having no contractions to speak of at the time. Also, as she checked, the rest of my water broke, and she was able to see the meconium for herself. She confirmed it was very dark and that there seemed to be a lot of it. At this point, we had a decision to make. The baby’s heartbeat sounded great, but all of the other indicators pointed toward that fact that there could be some distress, or that we could face problems at some point during delivery. After careful consideration, and a time of prayer, we made the decision to transfer care to our local hospital. I had prayed specifically for a female doctor should I need to transfer, and sure enough, a female was on call. When we arrived at the hospital, I felt a sense of peace, and I knew we had made the right decision. I finally started having good contractions after several hours, and by early morning on the 31st, I delivered a healthy, robust baby boy. He was literally pulled into the world in a quick and not exactly gentle way, to keep him from aspirating meconium, and whisked away to another part of the room for the first 20 minutes of his life to be hovered over and suctioned and monitored. t wasn’t the delayed cord cutting and skin to skin bonding experience I had envisioned, but he was healthy and thriving, and I was still with people I loved and trusted. He never left my sight, and I was on the way home before 24 hours had passed. My husband, mom, and my midwife had been allowed to accompany me into the delivery room, and before long, my son was handed over, smelly from the meconium but beautiful and perfect.
As I think back on the experience, I realize several key points that might help other people who choose a homebirth, and end up with a transfer, keep a positive perspective.
First, although transferring may not be fun, it can be necessary, and in no way means a failed homebirth. Jennifer Margulis Ph D, author of the book The Business of Baby, http://www.amazon.com/The-Business-Baby puts it this way, “A positive attitude towards homebirth makes so much sense and is one clue to how we can make our birthing system safer: a baby slated to be born at home who is instead delivered in the hospital should not be seen as ‘a failed homebirth,’ but as a safe delivery.” Equating the birth with failure makes you start to question your choice of homebirth in the first place. Instead, you should go into any birth choice understanding that things can and do change, and trusting God to help you make decisions that will lead to everyone’s happiest outcome, a healthy mom and baby.
Two, blaming your midwife is counter productive, and breaks down the beautiful relationship you’ve put time and energy into. If you think that your midwife is somehow to blame for the need to transfer, then you expose the truth that you may not have felt comfortable enough from the beginning to trust her with something as huge as you and your baby’s health. The decision to trust a caregiver completely is integral to the process, whether you choose home or hospital and needs to be made at the beginning of the relationship. Some caregivers may not deserve that trust, but delivery isn’t the time to discover that.
Third, put some time into understanding how payment for a midwife works. Many midwives in the United States can’t take insurance for a variety of reasons. The insurance industry is complex and at times almost impossible to work with. Many midwives have tiny practices and so the only choice they have left is to get paid cash up front. Some people balk at this, and it can become a sticking point when transfer occurs. I have heard people ask about receiving a refund from a midwife after a transfer. Asking for a refund implies that your midwife did not do the job for which you hired her. Usually, her fees are much lower than a doctor would charge for the same services, and if you transferred from a doctor after seeing him for all of your prenatal care, you would expect to pay him for all of those visits. Why should your midwife have to go unpaid if you end up needing a transfer? In fact, her expertise in recognizing things have progressed outside of normal could be responsible for saving your life or your baby’s. She has spent time with a client at prenatals, has run any needed tests, and has provided emotional support for months, but because the relationship seems so friendly, the clients can lose sight of her role as a professional who is working for her living.
Last, remember that what you see and hear on Facebook and through gossip cannot be addressed in any way by the midwife involved. When you see a negative post about a transfer from a client or client’s family, the midwife, who is bound by HIPAA, cannot comment to defend herself, or tell another side of the story. Families who didn’t support a loved ones choice to birth at home in the first place, often go into overdrive when a transfer occurs, and become a negative force to persuade other people to believe their opinion about homebirth. Stay reasoned and remember your reason for making the choice you did. Most transfer decisions are not made in emergency situations, so take the time to become acquainted with some of the reasons for transfer before the birth, so when the time comes you can understand and own your midwife’s recommendations, and can defend them as your own instead of getting lost in a sea of misunderstanding.
My story ended well, as do most births. Not everything went as planned, and I did have to work through some sad feelings about losing my ideal birth, especially where the bonding time after delivery was concerned, but I have a healthy little boy, an amazing midwife, and an intact support system that includes extended family and husband. A lot of that is thanks to having a flexible and healthy attitude about transferring. Being grateful to God for being in control doesn’t hurt any, either.