VBA3C homebirth: ruptured uterus, brain damaged baby

In December CNN published a story that received a lot of attention and approval among homebirth and natural childbirth advocates, Mom defies doctor, has baby her way. Mom, Aneka, made the decision to risk her life and the baby’s life based on the flimsiest of reasons, she watched Ricki Lake’s documentary, The Business of Being Born.

She found support for her decision from ICAN (the International Cesarean Awareness Network):

“She asked me if I could find someone who would deliver her vaginally,” remembers Bobbie Humphrey, who works with ICAN. “She started to cry because she’d heard ‘no, no, no you can’t do this’ so many times.”

But Humphrey told her yes, that she knew of a midwife who would be willing to deliver her baby at home.

Aneka and her son were lucky. They survived her risky choice, but Aneka and her on line supporters had no clue it was just a matter of luck:

“People were e-mailing Aneka saying ‘congratulations, you’re a role model,” Humphrey says.

Another woman did try to emulate her, with tragic results:

A girl who I went to college with had a baby around 10 last night & both are in critical condition. This is her 4th baby. She had 3 previous c-sections & was trying for a VBAC homebirth. Her uterus ruptured in several places & she lost a lot of blood. She is intubated & had 2 blood transfusions. She isn’t out of the woods yet, by any means. The baby was born blue & unresponsive, was resusitated, but showing signs of possible brain damage. She was flown to a different hospital than her mom. The baby is being kept in some sort of induced unconscious state currently. Please keep Lori & baby Vera in your thoughts & prayers!! Thanks.

Apparently Lori transferred to the hospital at some point during the homebirth attempt. Her sister-in-law wrote on her personal blog:

… Lori lost a lot of blood because the uterus tore in several places; the docs had to replace her blood twice over. She has been in the OR at Lehigh Valley Hospital from 10pm (1/27) til now 4:20am (1/28). When I left the hospital at 4:20am, the OR team was just finishing up. I was not able to see Lori or the baby. Right now, Lori will remain intubated for the next couple of days, and in the ICU. The doctor said she is not out of the woods, she is still critical, and has a long road to recovery.

Baby Vera is also having difficulties… Somewhere in the process of removing the baby, she lost oxygen. She was born blue and flaccid and needed resuscitative measures. She pinked up and her heart rate became strong, but she remained unresponsive and could not breathe on her own. Vera was medivaced via helicopter to Jefferson Hospital in Philadephia for a cooling process. The docs are hoping that by placing Vera’s brain and body in a slightly hyperthermic [sic] state, that her little body will reset. She is responding to pain, but her pupils are still not dilating. Vera is also considered critical.

Lori’s friend posted updates on the message board:

Lori is doing better. Her blood work, urine output, and vitals signs are strong and look good. When the nurses lighten her sedation, Lori is fighting against the breathing tube, which is a good sign (she knows it’s there)….

Vera, however, is not doing as well as the doctors wanted. She has little brain activity and her pupils remain unreactive. She is still intubated and in critical condition. They have her doing the cooling treatment and will be on it for 72 hours…

Update 1/29:
Lori is doing much better – breathing & talking on her own. She still has a long recovery, though.

The doctors are trying [cooling] treatment with baby Vera. The treatment is 3 days, then it’s just watch & wait to see what happens.

All of this leaves me with questions for the folks at ICAN who encourage women to take these life threatening risks:

Will you use Lori as a role model for VBA3C? Or will you wash your hands of her and pretend this never happened?

Update (2/3/11): According to the neonatalogists “…the MRI showed that a large amount of fluid had collected (hydrocephalus) and was putting pressure on parts of the brain, actually moving sections into different areas (herniation). The EEG showed minimal electrical activity from the cerebral hemispheres. The neurologist stated that there is some brain swelling as well as significant brain damage in a large part of her brain, but she is NOT brain dead. Vera still has some reflexes. What they believe Vera has is HIE, Hypoxic Ischemic Encephalopathy.”

Update (2/12/11): Vera died last night.

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  • J_in_the_Lou

    What are your thoughts on a VBA3C in a hospital setting? I am particularly interested in comparing VBA3C to CBA3C.

  • CoyoteFL

    Sheila, if you happen to get this… I’d love to talk with you. I’m a mom with 3 prior C-sections considering VBAC. I’d love to do it in the hospital because I’m afraid of the complications that could arise and not being in the hospital, but there are NO providers that will allow a VBA3C in my area! In fact, there are only 2 providers that allow VBAC after 1 prior cesarean and that is only if you meet all the criteria on their list… it’s ridiculous. DeFacto ban for sure.

  • JulieBeth

    A rupture is very rare but generally only happens during labor. Post dates doesn’t mean the baby is too big, it means she was past her estimated due date, and that is not a dangerous thing, statistics prove this out. Ever state has different homebirth laws, in many states midwives who are not CNM can practice legally, and a trained midwife is a safe birth provider regardless of the law. Doctors cause birth damage all the time, and they can only do so much to prevent complications. Each mom has the right to choose the birth option that is best for her. This same scenario could easily have happened if this was a planned hospital VBAC.

  • JulieBeth

    This same scenario could happen at a hospital birth. I had a doula client whose child lost oxygen because of the nurses unwise decision to cut the cord and stop all oxygen through it before beginning resuscitation. A ruptured uterus doesn’t show until blood shows or BP drops. Trying to infer that VBACs at home are dangerous because of one complication is foolish. The statistics show it is safe, midwives know when to transfer. Their good birth outcome statistics are better than hospitals. If hospitals had better birth policies more women would choose them but doctors like you who are alarmists keep that from happening.

    • Amy Tuteur, MD

      No, that’s NOT what statistics show. They show the complete OPPOSITE. But if you feel otherwise, don’t hesistate to provide us with the statistics from peer review scientific publications.

    • An Actual Attorney

      Even I (barely passed HS bio) know that “A ruptured uterus doesn’t show until blood shows or BP drops.” and “doula client whose child lost oxygen because of the nurses unwise decision to cut the cord and stop all oxygen through it before beginning resuscitation” aren’t factual statements.

      Hints –

      1. Hospital VBACs are continuously electronically monitored, why do you think that is?
      2. Where do you think the O2 come from if the placenta isn’t attached to anything?

    • Dr Kitty

      Hint, if the nurse wants to resuscitate the baby, it rather suggests the O2 from the placenta isn’t getting through in the first place.

    • The Computer Ate My Nym

      The statistics show it is safe, midwives know when to transfer.

      Which statistics would those be? Dr. Tuteur’s showed quite a lot of statistics that demonstrate the opposite. What do you have to counter hers?

      • Trixie

        And even if the midwife identifies a potential rupture in time, it’s going to be too late to get to the hospital and avoid disastrous consequences to the baby. You’ve got about 15 minutes to get that baby out at most.

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