Doctors and distances and induction

[stasya]

I have a complicated question for you guys. I am pregnant with my 3rd
child, 3 months along now. I live in a small town about two and half
hours away from the city where my ob-gyn's clinic and hospital is. (I
lived in the city with my first, and I liked her so I stuck with it
when we moved away with my 2nd). I was induced with both children. I
bled quite a bit with my first and had a hemorraghe with my second.
Personally I think that being induced was partially responsible for
this unusual bleeding and I don't want to be induced again. My ob-gyn
would simply break my water, out would pop baby two or three hours
later, and the placenta would refuse to follow. So I don't know what a
normal labor would be for me. Since it's my third, would it possibly be
a faster labor, maybe only 3-4 (or 1-2) hours long making a natural
labor risky so far from my hospital? I could set something up a little
closer to my home, but it would still be a 40 minute drive (and in
winter too, EDD Dec 20). And to a doctor who's not a specialist in a
small town hospital who I don't fully trust in the case that I'm simply
a bleeder and need any sort of emergency intervention. Please give me
some ideas,
Thanks,
T.S.

[Ericka Kammerer]

stasya wrote:

> I have a complicated question for you guys. I am pregnant with my 3rd
> child, 3 months along now. I live in a small town about two and half
> hours away from the city where my ob-gyn's clinic and hospital is. (I
> lived in the city with my first, and I liked her so I stuck with it
> when we moved away with my 2nd). I was induced with both children. I
> bled quite a bit with my first and had a hemorraghe with my second.
> Personally I think that being induced was partially responsible for
> this unusual bleeding and I don't want to be induced again. My ob-gyn
> would simply break my water, out would pop baby two or three hours
> later, and the placenta would refuse to follow. So I don't know what a
> normal labor would be for me. Since it's my third, would it possibly be
> a faster labor, maybe only 3-4 (or 1-2) hours long making a natural
> labor risky so far from my hospital? I could set something up a little
> closer to my home, but it would still be a 40 minute drive (and in
> winter too, EDD Dec 20). And to a doctor who's not a specialist in a
> small town hospital who I don't fully trust in the case that I'm simply
> a bleeder and need any sort of emergency intervention. Please give me
> some ideas,

Tough call. Yes, the induction could potentially be
related, or it could be something else (how long did they
wait for the placenta? how was third stage managed? was any
pitocin used?). There's no guarantee whatsoever on how long
an uninduced labor would last for you. Could be fast, could
be slow. If you want to stick with your current caregiver and
manage things differently, is there any way you can move back
downtown when you approach your due date (stay with friends,
extended stay hotel, etc.)? That might be the easiest approach.

Best wishes,
Ericka

[stasya]

I thought of moving back to the city, but the reason for my previous
inductions were because I was overdue for my dates, the first by one
week, the second by two or possibly a bit more. That's another reason I
don't really want to be induced unneccesarily because the babies were
born and assessed to be 40 week babies. So, its possible that I simply
carry mine for longer than average. So a hotel stay in the city could
be two to three weeks with two children under 4 without my husband.
Stasya

[Ericka Kammerer]

stasya wrote:

> I thought of moving back to the city, but the reason for my previous
> inductions were because I was overdue for my dates, the first by one
> week, the second by two or possibly a bit more. That's another reason I
> don't really want to be induced unneccesarily because the babies were
> born and assessed to be 40 week babies. So, its possible that I simply
> carry mine for longer than average. So a hotel stay in the city could
> be two to three weeks with two children under 4 without my husband.

If that isn't a possibility, my next recommendation would
be to establish a comfort level with more local facilities. While
they're certainly undesirable, postpartum hemorrhages generally
aren't the sort of thing that ought to require a state-of-the-art,
high end hospital to handle. Odds are, without induction you will
probably have some indication that labor is on the way (though you
may have some false alarms before you're in labor for real). With
such a long trip, obviously you would head for the hospital earlier
in the process rather than waiting for contractions to be really
close together. So, the problem exists if you have a very fast
labor and can't make it. If that happens, you will either figure
out that things are moving too quickly early on, in which case
you just head for the local hospital (or even call the paramedics,
if need be), or you find out once you are well on your way to
your preferred hospital, in which case you risk delivering
(or hemorrhaging) in the car. In that case, a cell phone
to get the paramedics to you might be in order ;-)
I don't really know what to advise that you do. Really,
a precipitate labor can happen to anyone, so anyone who chooses
to go a long distance to birth risks not making it. Given your
history, it seems unlikely that you would have a terribly long
and drawn out labor, but you could easily have plenty of notice
to get to your preferred hospital in time. I don't know nearly
enough about your situation to know whether your hemorrhages
are likely to repeat, or if they were due primarily to the
induction or some other aspect of your labor management. I think
it's certainly a possibility, but that's really something you'll
have to discuss with your doctor. Of course, given that it
was your current doctor who did the last two inductions, I suspect
he or she isn't likely to ascribe the hemorrhage to the induction
or labor management even if there might be a relationship.
Given your situation, it seems like the most reasonable
thing to do is shorten the distance you have to travel in labor.
I know you don't feel so good about the local hospital, but
maybe it would be worthwhile to check it out some more. Maybe
you'll find that it's quite able to handle your situation and
you'll feel comfortable having it as your backup plan, or even
as your primary plan. Or maybe you find out it's worse than
you thought and you realize you have to compromise somewhere
else ;-) Either way, you've got nothing to lose by finding
out.

Best wishes,
Ericka

[KC]

Generally labors after the water is broken are shorter, so your natural
labor may not be as short as the labors where the doctor ruptured your
membranes.

If in your shoes I'd probably stay home until I had some slight inkling
of labor and then go to the far away hospital (unless you thought the
labor was going fast, then go to the close hospital). Then if it turns
out to be not really labor, you could then start staying at a motel
near the hospital. Also, if you got to a week overdue, that would
probably be a good time to go stay close to the hospital too.

I bought an herbal product online from a midwifery supply store, but
never needed to use it, called HemHalt which is supposed to help stop
hemmoraging. You might want to buy something like that to keep with
you since you have such a long drive. If you can't find it by
searching, feel free to email me at kclaytor2 at yahoo dot com and I
will look up which store I bought it at.

KC

[Anne Rogers]

> Generally labors after the water is broken are shorter, so your natural
> labor may not be as short as the labors where the doctor ruptured your
> membranes.

I've not heard that before, I've had 2 precipitate labours, one with broken
water, the other with intact membranes. 1st my waters broke before labour,
2nd I requested ARM after over an hour of pushing with no progress.

to the original poster, have you considered homebirth? though unless there
is a midwife near you it would be the same problem, it's definitely a
difficult situation, sorry I can't think of some amazing idea!

Anne

[stasya]

Thank you for all the responses, they are much appreciated. The only
reason I don't go to the hospital right in town is because they don't
have a maternity ward, so they'd just call the paramedics anyway. The
closest hospital that handles maternity is the 40 minute drive away,
which isn't all that bad. As long as no one mentions that magical word
"push" to me, I'll probably be ok. I was just hoping there was an
option I hadn't thought of.

Thanks again!
Stasya