Dealing with Problems in Labor

Dealing with Problems in Labor

Problems in labor are the big bogey with which women are often threatened when they ask to have their babies at home. Statistically less likely to occur than in hospital, they are none the less a possibility. Although women choosing a home birth may be justifiably more confident about things going smoothly than their medical advisors are, they must, in order to make an informed choice, contemplate the possibility of things going wrong.

You need to think about what might happen, what contingency plans should be made for such an event, what treatment could be given to either you or the baby while still at home and when it would be advisable or necessary to transfer to hospital. You should also be aware of ways of preventing a problem arising if possible, or of helping yourself once it has.

Rates of transfer to hospital while in labor vary wildly. For examples, the NICE draft guidelines38 on intrapartum care show that transfer rates in labor vary from 32.4 per cent to 56.3 per cent for first time mothers and 1.2 per cent to 17.4 per cent for whom it is not a first baby, with wide regional differences — the highest transfer rates for booked home births both in pregnancy and labor being in the Northern Region, although the figures that they are using are ten or more years old. If it is recommended for you, you should be completely convinced about the need for hospitalisation, because it can be bitterly disappointing even when essential. If you are left with doubts about its necessity, or feel that it was for the benefit of your attendants rather than you or the baby, you can be left with a lingering sense of fury or frustration; Jan’s story illustrates this well. You may get some clue as to whether this is likely to happen from the prevailing attitude during your antenatal care, although lack of enthusiasm beforehand does not mean that your midwife will not help and encourage you in labor. Most feel that if you are definitely booked for home birth, then it is their professional duty to do their best for you in the circumstances. Unfortunately not every midwife sees an encouraging and positive attitude as part of her duty, so that it is as well to be prepared for this. If transfer is suggested and you do not feel convinced that it is necessary, you can ask the following questions:

— What is the indication for transfer?
— What benefit will it have?
— Are there any risks involved in that course of action?
— What alternative treatments are there?
— What will happen if nothing is done?

Of course you are dependent on truthful answers to these questions, and in some situations you may not get them if they are a reflection of the anxiety a midwife feels about home birth. In most instances, however, it will be apparent to you, and you will be grateful for extra help.

Problems arising in labor can be separated into those occurring before and after delivery. The difference is that in most cases problems arising in labor will develop gradually so that there is adequate time for a decision about transfer to be made if necessary. Problems at or after birth tend to manifest themselves suddenly and cause more alarm; it is these emergencies that most concern those opposed to home birth.

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