How To Cope When Plans Change

A home birth is a big deal — and when it doesn't go as planned, it can be stressful and depressing. Here's why a home birth may change to a hospital birth and how to deal with it.

Woman with doula

Home births constitute about one percent of all deliveries in the U.S. and a much higher percent in other parts of the world. That’s about 40,000 American babies born at home and doesn’t include mothers who planned on having a home birth, but for one reason or another, ended up transferring to a hospital.

Reasons for hospital transfer

Statistics on how often those transfers happen are hard to find. Suffice it to say, it happens fairly often.

The biggest reasons are:

  • Labor goes on way too long without significant progress
  • Midwife detects a problem with either Mom’s or Baby’s health
  • Mom gets too tired or is in too much pain
  • The umbilical cord falls into the vagina before delivery (prolapsed cord)
  • The baby is in an unsafe position for vaginal delivery (breech, transverse, etc.)
  • Mom starts bleeding heavily
  • There’s a lot of thick meconium (baby poop) in the amniotic fluid
  • Mom develops a fever, high blood pressure or some other ominous symptom
  • The midwife detects fetal distress

What happens next?

These transfers usually happen with a lot of stress and frequently a lot of drama and crises. Everyone (patients, families, their home-birth midwife and the hospital staff) is freaked out, frightened and worried. Once Mom gets to the hospital, an obstetrician steps in for the midwife and depending on the reason why she left home, the doctor and family make a new plan of care to get Mom safely delivered.

Sometimes, however, that new care plan is so drastically different from the home-birth plan that doctors and patients have a tough time going with the flow. After the cozy, non-intervention approach Mom was hoping for, a hospital birth includes a full load of interventions: fetal heart monitoring, IVs and sometimes Pitocin, epidurals, and C-sections; all administered by nurses and doctors who are essentially strangers. It causes culture shock and frustration for moms and hospital staff. That is, unless they already know each other.

Prepare in advance

Most “homebirthers” take prenatal education and childbirth preparation classes, study pain management techniques, prepare for breastfeeding and know everything there is to know about how to deliver at home safely. Some, however, fail to prepare an emergency back-up plan in case they have to transfer to a hospital.

How could these experiences have gone more smoothly? Read more here >>

Many women choose home birth because high intervention and C-section rates have made them distrust obstetricians and hospitals. Doctors and hospitals have to take some responsibility for that. But, when home birth doesn’t work as planned, it’s probably going to be a doctor and hospital that saves the day and patients have to take responsibility and let them. It doesn’t have to be a battle. It’s a birthday party, after all.

More on home birth

Home birth: Making it happen
Step-by-step guide to a home birth
Planning a home birth: Is it right for you?

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