By: Candace Roper
Planning for a hospital transfer might seem like the last thing you want to think about when expecting an out of hospital birth. That’s what I thought when I was having my first baby and planning a home birth. Then, at 39 weeks, I found myself giving birth in a hospital, well-prepared to have a natural birth, but unprepared for any other possible scenarios. After an 8 hour unmedicated labor and 3 hours of pushing, my posterior, asynclitic baby was delivered via cesarean section. I felt like the rug was pulled out from under me. I could not tell my birth story without crying for over a year. I was heartbroken and defeated, definitely not empowered. I experienced terrible postpartum depression, although I didn’t know that’s what it was.
Out of hospital birth transfers are the exception, not the rule. Most transfers are due to long labors or maternal exhaustion. Rarely, a transfer due to a medical emergency may be required. I believe it is wise to consider all possibilities, and then focus on the outcome you are planning and hoping for.
My second birth was another homebirth transfer, this time after a long and unproductive labor. That birth ended after 58 hours with many interventions, but because it was a vaginal delivery, I still felt somewhat vindicated. My third baby came 6 years later and was another attempt at a homebirth. This time I was able to stay at home, birth my baby vaginally, and get tucked into my own bed after all was said and done. It was an amazing and empowering experience, but certainly not a walk in the park.
When it came time for my fourth baby to be born, I planned another homebirth. My birth was quick and intense, only two hours of active labor before I began pushing. I pushed for about three hours at home before transferring to the hospital….again. I asked for and received an epidural, the OB attempted a vacuum delivery, which was unsuccessful. I decided that it was best for this baby to be born by cesarean.
My fourth birth, was much like my first birth, from the outside. Natural labor, extended unproductive pushing phase, stuck baby, posterior presentation. On the inside though, the two were not very alike at all. With my last birth, I knew I had made the best decisions that I could. I knew that I had tried everything. I knew that I had not failed. I knew that I was strong. I felt supported, happy, content, and even empowered. Here are the steps that I took that I believe made the difference in my experience being a positive one.
Taking a childbirth class might be the single most important thing you can do to empower yourself when preparing to give birth in any setting. When looking for a childbirth education class, make sure you find one that covers things you might need to know if you ended up in the hospital. Your class should prepare you with the knowledge of obstetric hospital procedures and interventions, their risks and benefits, and their alternatives. Knowing your options can keep you from being overwhelmed if you find yourself navigating a new environment and medical jargon. Learn about epidurals, pitocin, and even cesareans. Learn about when these interventions are beneficial, when they are not, and how to tell the difference. Learn about Family Centered Cesareans.
Hire a Doula
Hiring a doula for your out of hospital birth may seem like just another luxury expense because many home and birth center births can cost more out of pocket than in network hospital births. But, in the case of a hospital transfer, your midwife and care providers will facilitate the transfer, give the hospital your medical records and labor notes, and may stay with you, but also may not. Your doula will stay with you and will be an invaluable familiar face in the midst of change. In the case of a hospital transfer, a doula will provide the security of true continuity of care. Your doula will know you personally, your hopes and goals for your birth experience, and can help you navigate the hospital environment and stick as close to your birth plan as possible.
Make a Plan B Plan
When creating your birth plan, consider the possibility that hospital transfers do happen. It’s not a bad idea to create a Plan B (hospital transfer) birth plan and even a plan C (cesarean) birth plan. If you find yourself in those situations, what would be most important to you? Perhaps skin-to-skin with your baby after birth and delayed cord clamping. In the case of a cesarean, skin to skin in the operating room is an option you can ask for, and an hour of skin to skin once you are in postpartum is so essential for bonding with your new baby, but often overlooked in the hustle and bustle of the hospital.
It is possible and wise to plan for the potential of all outcomes, and to do so as early in your pregnancy as possible, so that you can write those plan B and C plans and then set them aside, and choose to focus mentally on preparing and planning for the birth experience you want to have.
The Power Of Positivity
It is common these days for pregnant and birthing women to listen to or write affirmations, positive, affirming statements like “Each wave brings my baby closer to me.” Affirmations are a powerful tool that can help the brain focus on the positive. Repeating affirmations actually wires the brain, strengthens the connections of positivity. Positive words actually change your brain. Once your original plan has been changed, thinking positively is often difficult or completely overlooked. When I found myself in the operating room for the second time, I was bound and determined to stay positive. I knew the science behind affirmations, and I was going to use them to my advantage. I repeated to myself in my head things like “My body is already healing. This procedure is going smooth and perfectly. My baby is strong and healthy.” I can’t convey in words how much of a difference these affirmations made in my mental and physical healing.
Postpartum Doula Support
Thankfully, I had already hired a postpartum doula before my fourth baby was born. I had no idea just how amazing having the support of a postpartum doula would be. Each day she came to my home, she asked me how she could support me that day. She complimented my mothering and offered advice and education on anything I had questions about. She folded my piles of clean laundry. She made sure I got a nap and a shower. She entertained my toddler and even wore my baby in a sling while she took care of things around my house. She made me snacks, tucked pillows under my elbows while I nursed, and even fed me bites while my hands were occupied with my little ones. Having someone to just take care of me, or finish the things on my to do list that were nagging at me, helped me to be able to heal, rest and process my experience. I had very minimal postpartum depression when I had a postpartum doula to support me, compared to very severe postpartum depression with my other three babies.
Allow Yourself The Space To Process
If your birth takes a turn for the unexpected, it is absolutely necessary to allow yourself the space to process what happened and how it felt for you. It is wonderful to turn to your midwife or doula, get their take on what happened and why, so that you can understand it from a logical sense. Then, take space to mentally process your experience, and write about it in your journal (or just on a page that you can destroy later if you aren’t the journal writing type). Talk to a trusted friend or loved one if you feel the safety to do so. Look for a compassionate birth professional, therapist, or support group if you feel that would be more appropriate for your situation.
And most of all, know this, birth is birth. Every type of birth is beautiful and profound. You did not fail, your body did not fail. Giving birth is an organic process and can’t be carefully planned, any more than an amazing sunset or thunderstorm can be planned. But, there are beautiful moments that deserve our focus, the first time your newborn looks into your eyes, the first time you feel their skin on yours, they way they look just like your partner. Take the time, whenever you get your first opportunity, to spend as much time as possible with your new baby skin to skin. Whether that’s the first hour after birth, or after an extended stay in the NICU. If you focus on the beauty of making tiny humans and marvel at the amazing, and sometimes wild process that is birth, surrender completely, and at the same time, own the experience that was your birth. You can choose to have a positive yet unexpected birth, and that can be better than okay.
Candace Roper is the owner of Centered Birthing Doula Services LLC. She is the mother to four amazing people. She enjoys teaching women and their partners how to have empowered births, supporting birthing women as part of a doula team, and offering breastfeeding counseling and postpartum doula care to new families. You can find more information about her classes and services at www.centeredbirthing.com.