Creating a Backup Plan for Home Births

When planning your home birth, don't forget to create a backup plan just in case. Start by talking to your midwife about the types of complications that would require a transfer to a hospital. In the event of a transfer, things will go more smoothly if you've made preparations like packing a hospital bag and writing a birth plan in advance for the hospital staff.

Why Is a Backup Plan Important?

There are a variety of pros and cons to having a home birth, and this decision is one that is made on a personal level. More and more American women are choosing a home birth, with 1 in 200 choosing this option. However, between 9 percent and 37 percent of planned home births end up with a transfer to the hospital during labor.
 
If you decide to have a home birth, you may expect (and hope) that everything will go smoothly. However, keep in mind this isn't always the case. In some cases, mothers need to be transferred to a hospital if complications arise during labor and delivery. Having a backup plan in place is essential if you choose to have a home birth to ensure the safety of you and your baby.
 

What You'll Need

Even women who have a low risk for complications may wind up having to be transferred, so it's better to be safe than sorry. So here are some things to consider when preparing your backup plan.
 
Make sure your midwife is licensed and legal in your state. If your midwife is not properly licensed, she may not be able to transfer with you to the hospital without fear of losing her license. If you are transferred to a hospital, you will want to have your midwife or doula with you to be your advocate and help your healthcare providers be aware of some of your desires.
 
Just because your home birth didn't go as planned, it doesn't mean that all your plans are out the window. Talk to your midwife or doula about putting together a hospital birth plan. This can help the healthcare providers and nurses be aware of your desires, and hopefully they can try to adhere to them as much as medically possible. Having this plan written out ahead of time can save you a lot of time at the hospital.
 
Although an emergency situation may not allow you many choices in some cases, having a birth plan in place can help with how you want the plan to look after your baby is born. For instance, you can explain that you want the baby to have skin-to-skin contact with you immediately after birth if possible. Some other things to think about putting in your plan may include:
 
  • Whether you want the umbilical cord clamped before the placenta is delivered
  • Your desires and wishes for breastfeeding
  • Allowing the placenta to be delivered naturally without the use of Pitocin®
  • Whether you want the baby to be in the nursery or with you
  • Whether you want your baby to have a vitamin K shot
  • The use or nonuse of erythromycin eye ointment
  • Your wishes regarding vaccinations
  • Whether you want formula or pacifiers used
  • Details about your baby's first bath
  • How you feel about healthcare providers giving your baby antibiotics or other medicines
  • Whether you will permit screening tests.
 
You may have to be prepared to fight for some of the items you put in your birth plan, as they may contradict hospital policy and perhaps even state laws. Try to be open-minded, too, and listen to the reasoning and logic behind some of the policies and laws.
 
But don't underestimate the power of a good birth plan. If healthcare providers see your desires and wishes spelled out and they approve it, provided it will not affect the safety of your or your baby's health, then many of your original plans can still be fulfilled. Also, make several copies of your birth plan just in case the one they have on file gets lost.
 
It can also be helpful to mention in your birth plan any allergies you might have. Also, if you have copies of your medical records, make sure to bring them with you to the hospital. This will be a good starting place for your healthcare providers in caring for you, and it can also save you from having basic lab work done while you are in labor.
 
When preparing your backup plan, some other considerations to think about would be how to get to the hospital. Would you require an ambulance, or would you have a friend who was strictly there on standby to transport you to the hospital if necessary?
 
In addition, some women find it helpful to have a hospital bag packed and ready to go just in case. If things do go wrong and you are transferred to a hospital, make sure your bag has some essential oils, good-smelling lotions, and other nice-smelling things that can help you feel a little more pampered in the sterile environment of the hospital. Some other items to pack may include:
 
  • Clothes that you can be comfortable in if you do not want to wear a hospital gown
  • Slippers and cozy socks
  • Some relaxing music
  • Your shampoo, hairbrush, makeup, toothbrush, and other cosmetic items if you want them
  • Snacks, such as oranges or other fruit, granola bars, other sources of fiber, something salty/crunchy, and your favorite drinks/juices/water
  • Change for vending machines
  • Insurance card and driver's license
  • Clothes for the baby and some soft blankets
  • Things for your partner, such as a toothbrush, phone charger, and clothes.
 
When preparing ahead of time, make sure you have already installed the baby's car seat correctly. Many mothers who are planning home births don't think about driving their baby anywhere right away, so having this done ahead of time in case of a hospital transfer is a good idea. Trying to install your car seat for the first time in the hospital parking lot may not be much fun.
 
Also, check with your transfer hospital and see if there is registration paperwork available that you can fill out ahead of time. This can prevent you from having to do it when you get there and give you time to read through it carefully.
 
Some mothers who are transferred to a hospital have also found that making a sign for the baby's bassinet is helpful. Since many healthcare providers and nurses may not read through your birth plan word for word, making a little sign that you can put on the baby's bassinet can be a good reminder for your wishes for your child. This little sign doesn't have to be too wordy, but can say something to the effect of, "Thank you for taking such good care of me! Please do NOT: give me any formula or pacifiers, circumcise me, give me a bath, or poke me with any needles without one of my parents here."
 
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