Homebirth logistics (ambulance with baby)

[hibiscuswool]

I'm 37 weeks now and am planning to have a homebirth. This is my second child, DD1 is 3. My plan was that DH would take care of DD, ideally get her out of the house, and I'd do the labouring/birthing alone (with midwives). I gave birth alone in hospital during lockdown the first time and I know I can do it again. I generally prefer to be left alone when ill, injured etc, so I'm perfectly fine with this.

However, the midwife mentioned that I should think about what would happen if I needed to be transferred to hospital after giving birth. Who would take care of the baby? I was really surprised because my assumption was that baby would always stay with mum. But apparently the ambulance won't let you take the baby with you. I can see that it's not super safe to be holding a baby while in a very fast moving vehicle and I'm planning on what to do in this case. I'm sure we can make it work.

But I'm wondering more generally now how this would work if you really don't have anyone and you are all alone. You can't leave the baby at home. Do you hand it to the midwives? And then what? And more broadly outside of giving birth. Say you're a few weeks PP, you have a bad accident while home with just the baby and need an ambulance. I can't imagine they'd just tell you tough luck, can't come with the baby.

So, how does it work? I appreciate this is a very rare situation but it must have happened before.

If a parent is admitted to hospital in an emergency the child will generally be cared for by a foster carer. Not sure what happens with a newborn who might be breastfeeding etc.

If you’re breastfeeding you are treated as one patient and baby comes with you. With an older bf baby or toddler they make adjustments so you can continue feeding

I work for the ambulance service. We'd take the baby. If you were too unwell for a kangaroo hold we'd need a car seat ideally. We have a harness but you couldn't both be on the stretcher at the same time. We'd get another crew if needed.

I'm a home birth midwife. We take the baby too, preferably in a car seat. Not ideal but they will send a second crew if needed, that would be very poor use of much needed resources though so I would have a look at if you have any other options re childcare of your DD.

Is there a grandparent/relative who can have DD so you can keep DH on hand instead?

I had my baby (accidentally!) at home and was transferred by ambulance with a PPH. Originally they wanted my husband to take the baby separately in the car but successfully argued that I needed baby to latch to promote the placenta coming out so he came with me ! He was fine snuggled up next to me

I was transferred ro hospital after birth as i was haemorrhaging. My dh was told he had to travel with me. My baby was sent in a separate ambulance behind us. We tried saying my dh would travel with baby but we were firmly told dh had to go with me.

Recently ambulance services have massively clamped down on seatbelts use in the back after a number of high profile fatalities, and resulting custodial sentences.

The only legal way to transport a newborn is in the additional harness that can be added to the stretcher, therefore if mum is the patient and is on the stretcher then baby can't come with you.

I had an unassisted homebirth 2 years ago, when the ambulance eventually arrived, they asked if we had a infant carrier which we didn't, so I just held baby on the stretcher with me.

I'm not planning a homebirth but this seems really strange, as surely there are many circumstances in a birth where BOTH the mother and child are in danger and need to be rushed to hospital? Surely they wouldn't just be like "sorry the baby will die without NICU but we can't risk him dying in a car crash so tough luck"?

It must depend on which ambulance service covers your area.

Unless you're so unwell that you're unresponsive (which is unlikely) please insist that the baby goes with you in your arms.

I had a home birth a few weeks ago and had to transfer for bleeding. My newborn went grey and 'crashed' twice in the ambulance after they said it's a policy they go in a car seat. Rescued by my quick thinking midwife. At less than 2 hours old my baby was still shocked and mucousy from the birth and on top of that the car seat restricted her airway. If she had travelled separately in the car with my partner I daren't think what could have happened.

I don't mean to scare anyone but it was the most horrific experience of my life after a beautiful home birth so i want to save anyone else that experience

Thanks for asking this question OP I’m planning a homebirth but it’d never occurred to me that I wouldn’t be allowed to travel with baby in the event of a post-birth transfer. I’ll ask my midwife when I see her this week but may well be a deal-breaker for me if true.

The legal responsibility for safety in the back of the ambulance is the drivers, and no one else, it will be the driver in court (and potentially prison) in the event of the death. The midwife is not involved in this decision, and it is certainly not something that the parents get to dictate.

The law is very clear that is is always the driver’s responsibility to ensure that a child under 14 years is properly restrained.

Many ambulance services are on their knees due to long delays in offloading patients at hospitals and the chances of getting an ambulance, let alone 2, to you in a timely fashion are extremely poor at times.

These are all factors that should be considered if you choose to have a home birth, and unfortunately for those who don’t choose a homebirth but have one anyway. You have 9 months think about contingency plans!

The link is to a campaign/ video currently being rolled out to all frontline ambulance staff, made in the aftermath of the jailing of an ambulance care assistant in wales for death of his patient, and the death of a student paramedic in the West Midlands https://aace.org.uk/safeintheback/#:~:text=Put%20simply%2C%20it%20is%20the,should%20be%20a%20rare%20occurrence.

Or in a car seat. There is no reason the baby wouldn't be able to be in a car seat strapped into one of the seats the ambulance.

The only time this wouldn't be possible is if the baby seat wasn't able to be secured by the seatbelt.

I had 3 home births and was never asked this . Anyway from what others have said it seems you just need to make sure you have a car seat

Could your parter be home but in a different room ? My children were home when I had mine.

Not all services will allow this. My understanding is that the forward facing seats in the back are not designed and tested for the purpose of attaching a car seat. I've certainly done it as the least worse option in the past, but the official line is not too.

Some of the newest vehicles have isofix points on the rear facing seat, but we have not be authorised to use it for this purpose, and I'm not sure how it would work as the baby would end up forward facing which is a much more vulnerable position for them. These seats also have an inbuilt child seat but this is not suitable for newborns (it's upright and has no head/neck support).

We therefore have harnesses that attaches quickly to the stretcher and are designed to fit a newborn.

If there are two patients then two vehicles will be required. This may result in a delay in care, but sadly this is not unique to mothers with newborn babies.

Don't know the answer to this specific question (sorry) but when my little boy needed to go to hospital in the ambulance (granted he was an older baby not a newborn) they just put him in the car seat which strapped to the chair via the seat belt. This is the same car seat we used when he was a newborn and faced backwards so don't see why they couldn't do that in your situation?

I had a homebirth and transferred in, held the baby in the ambulance and my husband stayed behind with the midwife to clean up a bit then followed in the car

When I was transferred to hospital in an ambulance my mother stayed with the older children and my DH came in the back of the ambulance with me. He held the baby in his arms. I wasn't in any kind of state to be holding the baby or having her next to me with passing in and out of consciousness.

I never thought I'd go to hospital but always organised someone to be responsible for the children who wasn't my DH for just this kind of reason.

Paramedic here,

Baby should under no circumstances be transfered in your arms in the ambulance. If the ambulance crashes or you become rapidly unwell baby will either go flying around the ambulance and suffer horrendous injuries or there will be no where safe for them to go if you can not keep hold of them. If mom is that unwell a second ambulance will be arranged (ideally home births get two ambulances anyway as there are two patients). Providing both mom and baby are stable then baby is safest in car seat and can travel in the same ambulance as mom. Generally (this bit is up to every clinician but its what I do and you can always ask for) is baby skin to skin if you feel happy with this until into car seat on ambulance or just by front door wherever is best to transfer then on immediate arrival at hospital, the moment the ambulance is parked baby is back in mom's arms all snuggled up under some blankets.

Hopefully this is a moot point and you have a lovely boring birth and everything goes perfectly and the ambulance service is not needed!

I'm not disputing your experience or the facts, but wanted to say that in a hugely traumatic birth, it has been of huge comfort to me that, at no time, was baby ever not at my side, even if held by my DH. Being separated from my baby would have added another layer of trauma and distress.

Not as much trauma and distress as if we'd had an accident and my husband or the baby had been hurt, of course. My DH sat on the opposite stretcher while the paramedic tended to me during the journey, holding the baby.

We haven't had ambulances with "opposite stretchers" for nearly 20 years, and the trust I work for is consistently the last to get anything new!

Your anecdote is very very outdated.

OP needs to make her plans based on current law and best practice, and that is one ambulance for mum, one ambulance for baby, both patients secured to their own stretcher, or if baby is well then family to arrange care or transport to hospital, whilst mother receives ambulance care.

Home births can be wonderful empowering things, however the last one I was involved in ended with a dead baby and mum in theater needing a blood transfusion. Don't be under any impression that it is all scented candles and coziness.

And whilst I fully respect that and I am so sorry that you had such a traumatic experience there are so so many things that can go wrong - as pointed out by someone further up the thread there have been incidences where there have been fatalities as a result of people being incorrectly restrained in ambulances. The only time anyone should ever be unrestrained in an ambulance is a clinician giving active treatment - don't get me wrong I know its not as black and white as that however the driver can and will/has been jailed previously for death by dangerous driving due to this. Its always the drivers choice but I personally would never risk it.

Again, I'm sorry that your experience was traumatic and equally I'm very glad that you take comfort from not being split from your little one because I can definitely understand why it would be a huge comfort for you! I think that's why it's such a difficult subject because I completely understand why you wouldn't want to be split from your baby even just by a car seat (and all the biological factors aside - latching to reduce PPH, golden hour and everything which is an ambulance service we tend to not be able to fully allow for the extremes due to midwifes wanting their moms and babies in maternity which is another issue in itself!)

I had a home birth and when discussing this midwife said that if I needed to be transferred to hospital I would go on own in ambulance and baby could come with dp in car or stay at he with dp.. If baby needed to go either me or dp would go with baby in ambulance ( adults in seat). And if both needed to go x2 ambulance as 2 pts and baby would be going to a&e and me to maternity.

Thank fully all went ok

Maybe it was a bench. I don't know, he sat on something on the opposite side. I wasn't really in a position to be aware of that detail.

No-one thinks homebirths are all scented candles and coziness or we wouldn't bother organising medical professions to be there just in case. I hope you aren't as flippant about the trauma some patients are experiencing when dealing with them. The two paramedics we got were great and did an excellent and caring job.