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.

Id be interested to know what % of full term planned home births end in the death of either the baby or the mother in comparison to the number of full term births in a hospital setting.

OK, that sounds a bit more compassionate. The awareness of my baby behind me helped give me a focus to try to stay awake, so was helpful. Of course you can't take risks and it would be much more traumatic to lose the baby in an accident, so knowing that rationale, I could have accepted the separation, even if it did add more trauma.

That's going to depend on your country, area, all sorts of factors. My statistics are out of date, so I won't give them, but homebirths were generally safer for low risk women when I birthed, in the area I birthed. You have to keep in mind that homebirth is skewed towards low risk women, so if there is greater mortality in the hospital it may reflect the cohort of women rather than inherent risk in the setting.

Low risk, I would always choose to birth at home, knowing I have a hospital nearby. Any higher risk factors I would always choose to birth in hospital.

For me now, I would have any birth in hospital as my personal risk factors, which were previously very low, are now very high.

Birth is a risk wherever though. Usually it's safe, sometimes things happen.

Off the top of my head I think it is approximately double (of a very small number) for first babies, less for subsequent, assuming a uncomplicated delivery of the first baby, but complication rates picks up again for multi-parity.

You'll need to Google it to check, like I would need to, as I'm just trying to remember statistics I read when I was pregnant a while back.

The problems really start when mothers insist on home births against advice, either for medical reasons or property access issues. There have sadly been a few of these cases in my area over the last few years with variable, but not great, outcomes.

Absolutely! And I do make a point of explaining it to parents as to the rationale of why baby needs to be secured and I've never had a parent have an issue once the explanation has been given but there's definitely that innate need for you to want baby right next to you it's just unfortunately in the situation of travel and safety safety has to come first.

Also @hibiscuswool I meant to say, at no point unless there is an acute clinical need to split you from baby - as in baby or you need to leave within minutes of an ambulance arriving - the odds of you being split from your little one (at least in the area my service covers) very very low providing you have a infant car seat.

Good luck!

The infant car seat issue is a difficult one, we are told not to do it, and it's frustrating, as it is by far the easiest option and the one where the baby looks most secure (compared to the paedi stretcher harness). But also I would be concerned having a very newborn baby in that position for any length of time due to the positional hypoxia issues. But we have longer travel times where I am compared to most areas, so more time for problems to arise.

This is another good point for consideration! You can probably guess I'm working in an area where our travel times fall within the 30 minutes recommended travel time in a car seat for a newborn so it's not something I've overly considered however it's a very good point to have made! Our stretcher harness are a nightmare to get a good fit on a newborn, nearly impossible if im honest! - are yours or do you find that they work quite well?

@Soontobe60

Look up the birth place study.

Here's a summary:

Planned home birth compared to planned hospital birth was associated with:
• Fewer interventions for all women
• Higher rates of normal delivery (88% of women planning a home birth
compared to 58% of those planning a hospital birth)
• An increased likelihood that babies were breastfed at least once
• No difference in perinatal mortality or neonatal morbidity for women who
had had a baby before. (Perinatal mortality was 2.3 babies per 1000 in
planned home births compared to 3.3 babies per 1000 in planned
hospital births in an obstetric unit and 2.4 babies per 1000 in midwife
led units alongside an obstetric unit, which is the default option for
healthy women with uncomplicated pregnancies at the Jessop Wing)
• An increased rate of perinatal mortality and neonatal morbidity for
women having their first baby (rising from 5.3 babies per 1000 in
planned hospital births to 9.3 babies per 1000 in planned home births)

I transferred in for a tear after my 1st home birth, I held baby in the ambulance thankfully.

Ambulance service is on its knees and not coping.
Do your bit and have the baby in the hospital.
My friend nearly lost her child in a HB. Just because you had a straight forward birth with one means that you will repeat your straight forward experience again.

I had a homebirth 8 years ago and transferred to hospital after (stiches). I asked if I should put the baby in a car seat and have my husband drive her in our car and the ambulance staff and midwife looked at me like I was insane and said no the baby comes with you, you hold the baby in your arms.

I did feel a bit weird bluelighting down a motorway with all of us strapped in except the baby but they all seemed to find this normal. I don’t think the car seat could have been strapped into the ambulance.

I think they were right as it is so important for both mother and baby to be able to smell and feel each other’s body temp etc, helps establish breastfeeding and keeps the baby’s breathing even (even at age 8 she still copies my breathing if she’s sleeping next to me and I take a deep breath!) but I do wish there had been some kinda seatbelt extension like you see on airplanes to strap the baby to me. Perhaps amazon has something you could buy?!

I had an (unexpected) home birth 8 months ago. When the ambulance eventually arrived, I was lucky enough to be able to walk to it, laid on the stretcher and me and baby were somehow strapped in and wrapped up under blankets together. Never even thought to question it!

We have the pedi mate+ for our Ferno stretchers which isn’t too bad to get on. Interestingly Ferno do KangooFix harness to attach to the straps around mum. Would be nice if the community midwife’s could coordinate with their local ambulance trusts and then carry them in their cars.

I have heard rumours about getting some baby pods, but they wouldn’t be on every vehicle, so I imagine asking control for one would receive much the same response as asking for a bariatric vehicle and/or stretcher.

I had an accidental home birth. First ambulance arrived 3/4 minutes after I gave birth. They called the other ambulance that was on its way tosay it wasn’t needed. I asked what was going on and they said they always allocated two ambulances in case both mum and baby need medical care. As my baby was fine the other ambulance was called off. We transferred to hospital with my baby in my arms, placenta in a bag between my knees and my DH following behind. We weren’t on blues and twos though, just needed stitching up!