Another HBAC: another rupture, another hemorrhage, another baby dies

HBAC stands for homebirth after cesarean. You often see it written with a number included, such as HBA2C, which means homebirth after 2 C-sections. In most cases, the attending midwife is violating her professional standards to supervise an attempted homebirth after multiple C-sections, but homebirth midwives think professional standards are for other people, not for them. Maybe that’s why they preside over the deaths of so many babies.

The latest completely preventable homebirth death is reported at The Guggie Daly:

Leilani had experienced two previous c-sections, with the last one being over 11 years ago…

But on June 15th, 2011, her precious son, Liam … was born still at 12:05AM. He weighed 10lbs, 5oz and was 22 inches long. He was chubby and perfect, with reddish brown hair and blue eyes like his daddy.

Leilani’s tragedy was rare and an extreme emergency whether at home or in the hospital. She had several hours of very hard labor with little progress when a severe pain across the middle of her abdomen appeared. It was extremely painful and did not go away.

The doctors verified she had experienced uterine rupture. This caused another rare emergency, a placental abruption, and this is what took Liam’s life. Her waters had broken and leaked into her abdominal cavity. It is a miracle that she is alive today. The doctors proceeded with a c-section after verifying that little Liam had passed on from this world. They had to clean out her abdominal cavity. Her uterus was shredded and the doctor spent a long time repairing it, but she will no longer be able to have biological children.

The doctors also diagnosed her with severe pre-eclampsia although she did not have that diagnosis during pregnancy, nor did she have symptoms.

Let’s see: a homebirth, 2 previous C-sections, a macrosomic baby, and undiagnosed pre-eclampsia. The perfect homebirth candidate!

And look how well it went. The uterus ruptured, the placenta tore away from the uterine wall and he baby died long before she ever got to a hospital. Way to trust birth!

As a bonus, the mother had a massive hemorrhage, extensive abdominal surgery and will be unable to bear any children in the future. Hey, ICAN, are you going to feature this story?

According to Guggie, uterine rupture is a:

… rare and an extreme emergency whether at home or in the hospital.

Not exactly. It’s far from rare, and is a known complication of attempting a vaginal birth after C-section. It is an emergency whether it occurs at home or in the hospital, but the difference is that in the hospital, they can save the baby’s life.

Even better, they can often prevent uterine rupture altogether by counseling women like Leilani that they are very poor candidates for VBAC and have a higher than average risk of this catastrophe. Had Leilani sought and followed the advice of an obstetrician, she would almost certainly be nursing and cuddling a live baby now, and probably bemoaning her “unnecessarean” as well.

This is what happens when you “trust birth.” You end up with a dead baby who didn’t have to die.

How many dead babies is it going to take before homebirth advocates realize that they have absolutely no idea what they are doing, and that precious babies are dying preventable deaths as a result of their arrogance and ignorance?

  • ADaily

    Maybe women wouldnt feel the need to have an hbac or an hbamc if they were “allowed” to labor in a hospital. Js i think vbac and vbamc should be done in a hospital so a woman has access to emergency medical care if necessary however. Most hospitals dont allow a vbac and mkst definitely dont allow vbamc. Every single one of my rcs were uncalled for but because i had just one i was forced to have 3 more. Hell my 1st cs was uncalled for but my ob wanted to go home and i had only labored 8 hours my baby wasn’t under duress i just wasnt moving along as he thought i should.

    • The Bofa on the Sofa

      i think vbac and vbamc should be done in a hospital so a woman has access to emergency medical care

      For the most part, they are, provided the hospital has adequate access to emergency care.

      The problem is that not every hospital has the emergency resources available to be sufficiently prepared for a VBACS.

  • Moms die from cesarean

    wow, Dr. Amy, that is the craziest lambasting of home birth I have ever read. While not everything you write is invalid, a good portion of it is. You share zero statistics to back your claims. Claiming you have accurate statistics somewhere else on your website just doesn’t cut it. They should be here, in this article. Instead you write bigoted statements. I’m so sorry for that woman’s loss. What a tragedy to live through.

    • Amy Tuteur, MD

      It is unethical pretend “midwives” such as yourself (as yet only a student) who are responsible for these tragedies. Homebirth midwives are uneducated buffoons who would b funny if they weren’t so dangerous. You know nothing, and make no effort to learn anything that doesn’t lead to your own profit. Babies and mothers die and all you and your colleagues do is avoid responsibility.

      Don’t waste your money on pretend midwifery. If you about mothers and babies (as opposed to your own financial benefit) you will get a real midwifery degree, not a pretend credential designed to fool the public.

    • Medwife

      This story was an example fleshing out the REAMS of posts discussing research. I don’t think you’re carrying away what you should from this post. Do you think it’s outrageous because a midwife took on and kept this client for a home birth, or because most midwives (supposedly) almost never take on such clients and you see it is fear mongering, or because you think the only standard for being a homebirth candidate is the desire to have one?

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  • Dmcose

    It’s writers like you why women doubt themselves in childbirth. This article is a shame and distorted twist of the truth. There are many factors to this story that have been left out and if a mother reads this, she only doubts and fears her birth more. Thank you for opening my eyes to the negativity and ignorance childbirth faces in this country.

    • Young CC Prof

      Are you familiar with the phenomenon of victim-blaming? When we hear about something terrible happening to someone else, we need reassurance that it won’t happen to us. So, we look for everything that the victim did wrong to cause the tragedy.

      Rather than look at this woman’s story and admit that home birth after Cesarian is dangerous, that any scarred uterus can potentially rupture, especially when labor is inadequately monitored, you dig for other reasons under the surface.

  • ElRubio

    I’d love to see some numbers. Do you have statistics to back up your theory that home births are churning out dead babies left and right? No? Because this article is not fact based. Doctors need to stop turning to c sections every time things get rocky during birth. It’s the easy way out, and a good doctor will tell you that. Hospitals treat ONE kind of patient, however, every woman and every birth is different. Doctors should be doing WHATEVER they can to prevent a c section, not bullying women into major surgery because “12 hours is too long to labor”, or “things aren’t progressing the way you’d like them to”. How about countries where midwives, and home births are the norm? Let’s compare birth statistics with them. You’re a disgrace to the medical profession. Midwives aren’t a bunch of uninformed hippies, neither are their patients. Trying to terrify people out of considering vbac, whether in a hospital or at home is not the job if a medical professional. Your job is to make sure women are informed enough to make the best decision possible for themselves. However, to do that you first need to educate yourself.

    • Young CC Prof

      Keep reading, the statistics are all over this blog. The death rate in home births is at least three times as high as in hospital birth. Countries where midwives and homebirths are the norm? Britain and the Netherlands have a higher perinatal mortality rate than the USA, despite universal health care. (8 per 1,000 vs 7 per 1,000)

      And no, doctors should not be doing “whatever they can to prevent c-sections”, they should be delivering babies alive and healthy with a minimum of damage to the mother, by whatever means is best in that particular case at that particular time.

    • toni

      ‘Doctors should be doing WHATEVER they can to prevent a c section’. I think you’ve fallen off the edge of reason there. No one who actually cares about women’s health would say such a daft thing. Admit it, you just don’t believe getting a baby out by caeserean is a legitimate way to give birth and anyone who would prefer it over a vaginal birth is crazy (sorry, ‘uneducated’)

      Countries where homebirth and midwives are the norm? Well it’s in the third world where they are most common and they’re not doing so hot there. I went to school in Kenya as a child and even amongst the middle class kids I knew it was common for them to have brothers and sisters that died during birth. Yes I know you are alluding to Holland (this is all boilerplate stuff you’re coming out with) but if you really care to know Dutch obstetricians have better outcomes than Dutch midwives. (And by better outcomes I mean they have more live births not less c-sections)

      • childofGod

        I almost bled to death during an unnessicary c section because I was in labor too long…. I’m proof of how pushy doctors can be on c sections. I give the doctors NO credit!! I give my Lord and Savior JESUS CHRIST the credit of me living through the birth. doctors get more money for performing major procedures. I do understand some women need c sections to save their or their baby’s life… but I wasn’t one of them and it almost cost me my life…

        • Long labors come with an increased risk of PPH! Had you had a vaginal delivery, you still would of experienced this. BECAUSE YOU HAD A LONG LABOR.

          Your God tried to kill you and those doctors saved you.

          • Bodnoirbabe

            Childofgod says “LALALALLALALA CAN’T HEAR YOU!”

        • Stacy21629

          Actually, most OBs get paid a flat fee – no matter the delivery type.
          Prolonged labor is a risk factor for post-partum hemorrhage.

    • The Computer Ate My Nym

      Do you have statistics to back up your theory that home births are churning out dead babies left and right?

      Yep. All over this blog. With sources to back them up.

      Doctors should be doing WHATEVER they can to prevent a c section,

      Why? Doing “whatever they can” to prevent a c-section means more babies dying because the doctor (or midwife) tried to prevent a c-section, even though it meant letting the labor go on too long or using forceps, more vbacs turned to rupture, more use of medications to induce or enhance labor, and so on. It also means more emergent c-sections because doctors wait longer even when the writing on the wall is clear because they want to do whatever they can and occasionally things might work out. What’s the upside?

      Hospitals treat ONE kind of patient,

      Um…huh? I’m not even sure what you mean by this. The whole point of the monitoring that goes on in a hospital is to know when THIS patient is not doing well, when THIS baby is not tolerating labor, when THIS situation is getting dangerous. If it were really one size fits all, we wouldn’t need monitoring and tests. We’d just sit there and knit until the baby was born. Or died. Whichever.

      • toni

        I’d like to add in regards to the ‘hospital treats one kind of patient’ comment that I delivered with an obstetrician at an American hospital and had just one intervention (AROM) which the nurse suggested an an option that was entirely up to me. They did nothing else to me because my labour was progressing fine so it’s hardly as if they just do things to you for fun.

        • The Computer Ate My Nym

          Yeah. My sister had two births in hospital with epidurals and no other interventions and one completely intervention free birth. I had a c-section. Which one of us was the “one kind of patient” hospitals treat?

          • Young CC Prof

            The human kind of patient, maybe? That’s about the only thing that all hospital patients have in common.

        • Bombshellrisa

          As a nurse, I can tell you, if it ain’t broke, we won’t fix it. Interventions mean more time, more involvement and if you are “boring” (progressing without complication), we are not going to create more work for ourselves!

    • Box of Salt

      “Doctors should be doing WHATEVER they can to prevent a c section”

      Wrong, wrong, and more wrong.

      Doctors should be doing whatever they can to prevent the death of their patients.

  • hba2c and willing!

    There are risks of fetal or maternal death regardless of where a baby is born. I nearly died after my last c section in a hospital and they continued to slowly kill me through testing. Every CT scan I did killed my kidneys to 36% function and just as I was being wheeled into another CT scan to try and find what was wrong, I was stopped by a concerned midwife who wanted to do an ultrasound first and found a 10cm long abcess, Dr’s confirmed it was a fragment of placenta (i.e. placenta was not cleaned out well during c/s procedure) and became infected. If they had not found it in time or did another CT Scan I would have died for sure, leaving two babies and a husband behind.
    Hospitals don’t talk about the maternal or fetal deaths they encounter either. Only difference is homebirths do not force a mother to undergo unnecessary medical intervention for the sake of “doing something” to look like they’re saving mother or baby. Homebirth mums know the risk they are taking both in homes and in hospitals and are still willing to avoid hospitals… I think that should send a BIG message to OBs and Hospital staff everywhere!

    • Yes there are risks regardless – but the risk of dying an otherwise avoidable death is higher at home than in the hospital. If I’m going to die, I’d like to know that there really wasn’t anything more that could have been done to prevent it. Similarly, if my child is going to die, or be left permanently disabled, I’d like to know that it is not a result of a decision I made to have life saving equipment and procedures inaccessible when they were needed.

      Frankly, if I were in your position, I’d order my medical records and debrief with someone who is able to determine what happened and answer any questions I may have. I definitely wouldn’t be joyfully accepting the risks of a hba2c….

      • hba2c and willing!

        They have been ordered. I’m currently going through litigation with a medical lawyer about what happened to me. I meet with a bunch of HBA2C women regularly and not one of them knows of a case of a mother or baby dying in a homebirth. This is one random case (no doubt, it could happen at home or at hospital regardless) and its not scaring me one bit. I know the risks I am taking and they’re just the same. Please see above if you want stats.

        I’m very happy with my decision because I know I have a wonderful team of medical professionals with me including the best homebirth midwife in the state and my files at my local hospital four minutes from my home. I have such peace at my decision knowing how hospital staff ruined not only my ‘birth’ but my body, my psychological condition and my ability to connect with my child. I refuse to be forced into further medical interventions that are not necessary for the majority of cases and if I am one of those women who do require medical intervention after trying, then I am ready and can quickly get it. That is me being prepared to be a responsible homebirther.

        • Amy Tuteur, MD

          Not one of them knows of a case of a mother or baby dying in a homebirth in Australia? Are you serious?

          Lisa Barrett, alone is responsible for 5 homebirth baby deaths, and there are homebirth deaths of babies each year in Australia. Caroline Lovell is a mother who died at homebirth in Australia in early 2012.

          How can you make an informed decision about homebirth if you don’t know even the most basic information about the risks? Obviously, you can’t.

          • hba2c and willing!

            I can assure you, the women I have spoken to cannot name a single maternal or foetal death from a homebirth. Here in Sydney, 2206 children die during childbirth per year, and only 4 of those are homebirth cases.

            I have made a decision based on my own case, not on the cases of other women, or the rare cases that occur in hospitals or outside of them. Its one thing to die at your own risk, another for a doctor to kill you. I am in anguish for a mother who was killed at the same hospital I birthed at last year, due to the simple mistake of injecting an antibacterial solution into her spinal cavity instead of the epidural. An unnecessary death from carelessness. A rare case, sure, but like any rare case, these things do happen.
            I have made a decision, its personal and its based on the fact that OB’s are just as flawed as homebirth midwives at times, and based on the facts, figures and information I have discovered and followed up on.
            Are any of the statistics I have given incorrect or misinformed? If they are, please advise, but I’ve given stats and figures that I have based my rational decision upon.

          • Amy Tuteur, MD

            You are frightfully misinformed. You seem to have trouble with basic math, for example. When comparing the risk of hospital and homebirth, you must compare the RATE of death, not the absolute number. 4 homebirth deaths is an extraordinarily high death rate since there are very few homebirths and tens of thousands of hospital births. Moreover, hospital deaths are primarily premature babies and babies with severe anomalies. Homebirth deaths are typically babies who are not premature, have no anomalies and would have survived in a hospital.

            You have every right to choose homebirth regardless of the risk, but first you have to understand the actual risk and you don’t have a clue.

          • hba2c and willing!

            Of course, hospital foetal deaths could mean anything, and yes, out of the 220,000 deaths in hospital in Sydney alone, 2202 die every year, seems just as small as the 2000 odd women who homebirth and lose 4 babies per year. That means 1% of babies born in hospital die, as opposed to 0.02% of homebirth babies dying (if my maths serves me- it may not, its not my forte). I acknowledge that more babies would be lost as such high numbers means a higher mortality rate, and I also acknowledge that birth defects, complications, premature labour etc. count for that number too.

            I thank you for acknowledging my right to choose a homebirth, it means a lot, considering what I have suffered (literally unnecessarily- I had a low risk pregnancy, was a week overdue and was put through the circus hoops of induction because Drs had no reason to wait, which led to C-sections and consequently physical and psychological difficulties for months thereafter). I also do hope you reconsider telling a mother- who is doing the best she can in terms of research for the benefit of her baby and for her own wellbeing- that she does not have a clue and has not calculated the risks involved. It does not suggest a kindness or a concern for her best interest to admonish her choice as ‘cluelessness’ when she is doing a great deal of research, is still searching through medical files, documents and cases, is speaking to medical lawyers, doctors, midwives and other mothers to learn as much as she can, even entering into a discussion in a blog like this. I am not attacking you, you are just as entitled to your opinion as I, I just wish your article came more from a place and tone of concern rather than a crusade.

          • Amy Tuteur, MD

            When you compare hospital to homebirth, you must compare like with like. That means you have to look at the death rate for term babies in the hospital, which, according to Australian govt. statistics, is 0.4/1000.

            Since there are less than 800 homebirths per year in Australia, 4 deaths is a death rate of 5/1000. That’s more than 10X higher than the hospital death rate.

            Do not kid yourself. You have not done research. You’ve read books, websites and message boards filled with laypeople passing misinformation back and forth. Research involves reading medical textbooks and journal articles and you haven’t done that.

            You aren’t educated about homebirth; you are ignorant and your baby and you may pay a terrible price for that ignorance.

          • Guest

            Well, I appreciate your ‘kindness’ about my ‘ignorance’. I wonder how a female doctor interested in the female body and the power of the birthing process can be so cruel and judgmental about women’s choices, especially when they’ve sought more info from the opposing view and read this nonsense?

            This blog is misinformed, there are more than 800 homebirthers every year in Australia, as I responded to another comment, there are 1200 in my conference group in Sydney alone. I have actually read journal articles and have documented the number of homebirth litigation cases in an attempt to discover what went wrong, I have a medical solicitor who has been feeding me with information from his failed birth cases and though he admits the most painful ones are homebirth cases, the majority of cases he sees are with unprofessional hospital staff who have not shown a duty of care, failed to provide adequate care, or did not intervene in a timely or effective manner.

            I think youre being quite ignorant also that there is a possibility that you are riding all your hopes of changing minds on these random horrible stories that you find. Absolutely they are tragic, but they are just as tragic as some of the horror stories I’ve heard coming out of labour wards and operating tables. They are also quite rare, less than 1%.

            Oh, and if I pay the price for my ‘ignorance’, it is on my head…. thanks for the ‘kind’ warning!

          • Amy Tuteur, MD

            “so cruel and judgmental about women’s choices,”

            I’m not judging your choice; I’m judging your terrible ignorance.

            For example, you say:

            “Here in Sydney, 2206 children die during childbirth per year, and only 4 of those are homebirth cases.”

            That is flat out wrong.

            According to Australia’s mothers and babies 2010 (http://www.aihw.gov.au/publication-detail/?id=60129542376), there were 2206 FETAL deaths (stillbirths) for the ENTIRE COUNTRY, not for Sydney.

            But when we talk about homebirth deaths, we’re not talking about FETAL deaths; we are talking about NEONATAL or PERINATAL deaths. You apparently don’t know the difference.

            There were 641 NEONATAL deaths in the entire country in 2010, and most of those were premature babies or babies with anomalies.

            Unless and until you compare deaths at PLANNED homebirth with deaths at comparable risk hospital birth, you’re just spouting nonsense. And in your case, you’re belief in nonsense could be deadly.

          • Your math is off. If your numbers are right, ~1% of all babies (including premature, fetal abnormality, and high risk babies) born in hospitals die. ~0.2% of homebirth babies die, but these are all low-risk. What is the rate of death in a hospital of low-risk, singleton births to healthy mothers? You can’t compare overall death rates because the populations are different.

            A BMJ study puts the perinatal mortality rate of homebirth in Western Australia as being~1.5x higher than hospital births. I would double-check your numbers, if I were you. http://www.bmj.com/content/317/7155/384

          • hba2c and willing!

            Homebirths in Western Australia are mostly Doula assisted or Unassisted as the support of independent midwives has been attacked so viciously and homebirths driven underground. I can understand that things would go wrong without medical professional presence, thus I am a big advocate of a midwife assisted homebirth, if not a hospital-linked homebirthing program like some of the hospitals have here in Sydney.

            Unfortunately, we will never know the true number or reasons behind foetal deaths in childbirth. What we are not taking into account is the number of women who have chosen to homebirth their already stillborn babies. I know 6 women in my own circle of homebirthing mothers who have chosen to go through the labour process after learning at 30+ weeks that their babies had died in-fetu. They still opted for a homebirth and that figure still counts to that -0.2% Like I said, we’ll never really pinpoint the true accuracy of these figures

          • Women give birth to previously stillborn babies in hospitals too. If you’re going to use that to excuse the homebirth death rate, you’re going to have to use that to excuse the hospital death rate too.

            You will note that 50% (half!) of the homebirth deaths were asphyxia at birth. I can’t repeat that enough. At least half of the babies that died at homebirth most absolutely, positively didn’t have to die. Hospitals loses babies from asphyxia so rarely these days, and everyone involved is grilled and then sanctioned for an avoidable death if it does, that the fact you don’t see this is a problem is … shocking.

          • Dr Kitty

            Info on Caroline Lovell.
            You need to read it.
            http://www.mamamia.com.au/parenting/home-birth-campaigner-dies-during-birth-of-second-child/

            There aren’t 2000 planned home births annually in Australia, there are less than 800, with the remainder being babies born unexpectedly at home due to precipitous labour, which is not the same thing.

            4/800 = 1/200= 0.5% chance of a planned Homebirth in Australia ending in empty arms and a broken heart.

            0.5%, BTW is also the lowest estimate of the risk of your scar rupturing during labour. If that happens at home it is almost certain your baby would die, and your own life would be at risk.

            HBAC in Australia therefore has an best case scenario risk of 1% of your baby dying. If you are comfortable with those odds, well ok.
            Except I don’t really think you are comfortable, because you keep trying to pretend the risk is much lower than it is.
            If we’re right about the risk, are you still comfortable with it?

          • hba2c and willing!

            Actually the figure for homebirths in Australia fluctuates between 1800-2000 annually (that is including accidental homebirths), don’t know how you came up with 800, I am part of a group of 1200 for the 2012-2013 HBAC group!

            As I said earlier, the percentage varies from 0.5% for a first time VBAC and 0.8% for a VBA2C… thus it is still less than 1% for a HBA2C… a risk that would occur in a hospital if my OB is willing to do a VBA2C (which in Campbelltown, they have offered, but I am quite sure its a bait-and-switch scenario).

            I don’t know why you doubt I would be uncomfortable about my odds of a successful HBA2C… why would I reply to these posts with my facts and beliefs otherwise? I am certainly comfortable with my 99% chance of successfully homebirthing, considering my odds of surviving a ‘successful’ C-section and paying the price physically and psychologically thereafter.
            In answer to your question, yes, I will still take my chances, based on an educated decision and based on the fact that I am preparing for the worst as well as the best.

          • Amy Tuteur, MD

            “Actually the figure for homebirths in Australia fluctuates between
            1800-2000 annually (that is including accidental homebirths), don’t know
            how you came up with 800”

            Because those are the PLANNED homebirths and those are the only ones that count.

    • Young CC Prof

      Why exactly do you think that CT scans cause kidney failure? The infection was causing the kidney failure, and the CT scans had nothing to do with it. Now, the hospital probably screwed up by not discovering the problem earlier, but they did find it before permanent harm was done. I agree with Mrs. W, request your records, and possibly file a complaint for poor care.

      And no, homebirth mums don’t understand the risks. If they did, they wouldn’t home birth.

      • hba2c and willing!

        The Drs had spoken to me about the risks of doing another CT scan, citing that the radiation as well as the isotopes from the prep fluid were going to affect my kidney function and stop me from breastfeeding for 24hrs.
        Trust me, I’m already going through litigation about what happened.

        Oh, I DO understand the risks! Uterine rupture sits at 0.5% for a first time VBAC and at 0.8% for a VBA2C, at 0.9% for an induced VBAC (yet they were happy to induce me when I went in for my VBAC last time)! Funnily enough, OB’s are more than happy to refer women for an amnioscentesis when the risks of a miscarriage following this type of testing are exactly the same as a uterine rupture! For those who do suffer a uterine rupture, only 6% of those cases are catastrophic.

        I believe that this one story is sad, definitely, but it is an extremely rare case and would have occurred in hospital also, with no guarantee that the baby could have been saved either. It sounds like her midwife was quite foolish to let her hold off with the pain for so long and not recognise the symptoms of pre-eclampsia.

        No woman in her right mind would choose a homebirth without calculating the risks to herself and her baby. I know I am four minutes away from my hospital should I need to transfer and they know that I have decided to homebirth, thus have my notes with them. If my placenta is resting on my scar, I’m calling off the homebirth. If anything changes in my low-risk pregnancy, I’m going to hospital for sure. But how can anyone expect me to go under the knife again after the physical and psychological damage that has been done to me?

        I cant tell you the number of cases I know of women who have either died or had dead or disabled children during childbirth in hospitals- just because you have access to a hospital doesn’t always mean that survival is guaranteed.

        • Young CC Prof

          4 weeks feverish, starting soon after birth? And it took THAT long to find retained placental fragments, or figure out that you had some sort of endometritis going? Yeah, that hospital dropped the ball in a big way. Definitely pursue the matter.

          For the future, it sounds like you do have a straight notion of what can go wrong, and you are doing prenatal testing to check for problems. That puts you ahead of the mothers of about half of the homebirth disasters I’ve heard of.

          Make sure your midwife isn’t a “cowboy,” that she has a decent relationship with the hospital and is willing to transfer immediately if signs of a problem appear. That would prevent quite a few other potential disasters.

          Realize that if you do rupture out of hospital, the probability of death to one or the other of you is pretty high, as you probably won’t be able to reach an OR in time to retrieve a live baby. It’s your body, however, and, if you understand the risk, no one can force you not to do it.

          • hba2c and willing!

            Thank you for understanding. I know that it may seem daunting to be outside of medical intervention, but when it was medical intervention that had me on the brink of death in the first place, its understandable that I would want to turn away from all that, surely. I know its not for everyone, which is why I don’t go enforcing it on others, but I certainly don’t go bagging out those who birth in hospitals the same way this Skepticalob has. I don’t think its a one-case-fits-all scenario.

            We have interviewed a number of midwives and we’ve chosen this one because she really is the best at what she does and has worked in hospitals and at homes for many years. She’s fantastic, and again, we are only 4 minutes from a hospital and I’m seeing my GP regularly (all my pregnancies including this one are low risk) so I definitely will not let her push anything on me that I’m not comfortable with (which is unlikely).

            With the hospital only 4 minutes away (and I have a number of connections at the hospital- several drs and nurses) they will be notified as soon as I go into labour and will be notified if we do make a move to the hospital at any stage so an OR can be prepared as quickly as possible. Yes there are risks, but I’m doing all I can to manage them with the many professionals I am in contact with.
            I agree, the homebirth mothers who are NOT doing their research or preparing a back-up plan are not homebirthing wisely, which is why I question and prepare everything now. I just hate seeing blogs like this which deem all of us as crazy, when really, the risks are almost exactly the same, if anyone is unprepared.

          • Young CC Prof

            It kind of sounds like you’re in Britain? Home birth is pretty well integrated into the health care system there. It’s not as safe as hospital birth, but it’s not outrageously dangerous.

            Here, in some US states, folks with very little training and no connections to the rest of the health care system can call themselves midwives, which is a key component in many home birth disasters. Often their clients don’t realize how inexperienced and underprepared their providers are. A CNM is a real qualified midwife, a CPM has far less training and may never have seen a birth emergency before.

            Home birth after c-section isn’t objectively the smartest thing to do, but I understand why you want to do it, and it sounds like you are aware of the risk and doing it in the least risky way possible.

          • hba2c and willing!

            Actually I’m on the other side of the globe. I’m from Australia.

            I understand that training and registration varies from provider to provider and that’s why its wise for a homebirther to investigate their provider as much as possible. I’ve got records of mine dating back as far as 2009!

            A homebirth after C-section carries less than 1% risk of a uterine rupture, which is the complication most OB’s seem to talk about. That means I have a 99% chance of birthing successfully at home, and a 0% chance of birthing vaginally in a hospital and a 7% chance of dying on the operating table. A uterine rupture can occur with those who have never had C-sections too, that’s at 0.2%. That’s only 0.3% less than a HBAC and 0.6% less than a HBA2C!

            Thank you for the compliment of understanding why I would take these risks and seek an alternative. I’m not one of those birthing radicals who lights up incense and beats bongos during labour (just not my thing) but its the only way I will be given the safest and most effective birth I want. I would love to do it in a hospital if hospitals looked and treated birth differently.

          • Young CC Prof

            Keep in mind, those stats may vary depending on the reasons for your original c-section and how big the new baby is, and how he presents.

            I do not honestly believe that the home birth is safer, but I do understand that the hospital screwed up in your case.

            And then of course, I get the impression that there are some structural issues with maternity care in Australia. Many of them are actually related to too little intervention, or not enough intervention at the right times, possibly due to lack of resources. Here in the US, if you’ve got the money, they’ll do it right. (Of course, that could easily run to $30,000 cash, if you don’t have insurance, which is a whole other problem!) In fact, Australia’s perinatal death rate is actually a bit higher than ours, which isn’t a great sign.

            So, if you’re really upset by poor hospital care, get out there and agitate for better maternity care for all Australian mothers and babies!

      • hba2c and willing!

        Btw, it wasn’t permanent damage, no, but I spent four weeks in hospital trying to figure out why I was feverish, not eating and not able to move or carry my baby, 3 months trying to recover from the infection after the problem was found, and a further 10mths post birth doing further testing and reviews to see how my kidneys were recovering.

        Sure, you can definitely say that’s better than death, and I am so thankful, but I did not have to have a c/section in the first place!!!

  • Carrie

    Don’t be dupped by the medical industry. It’s not about an “experience” it’s about your child having the best chance at life and growing up without disease. If you think induction, forceps and laying on your back is how birth is supposed to be you are ignorant to the truth.

    • Young CC Prof

      “Don’t be dupped by the medical industry. It’s not about an “experience” it’s about your child having the best chance at life and growing up without disease.”

      I would say rather, “Don’t be duped by the natural-birth industry.”

  • Carrie

    This is a really ignorant article. Considering how many babies are lost during hospital births and how many complications arise from unnecessary csections. An emergency is an emergency no matter how you swing it. If she had severe preeclampsia then yes she was not a home birth advocate. But there is no need to punish those of us who are extremely healthy and focused on nutrition and love. I had a csection because a doctor was too lazy and tired to do a natural birth plan… Oops… I said it. Guess what? I had a very successful home birth last year and it was one of the most amazing experiences of my life. My baby is one of the healthiest I know and we are so connected. Midwives rock and doctors need to app treating women like defects who can’t handle a natural process. What’s next- checking our children into the hospital when their baby teeth fall out?? Having a monthly hospital stay when menopause sets in? Please. This country needs prayer.

    Carrie

    • Young CC Prof

      90% of babies are born fine without medical intervention. Me, I’d rather have a 99.99% chance of a fine baby, no matter what it takes.

    • Unnecessary c-section – say I didn’t know you had a crystal ball that worked with 100% accuracy. It is impossible to tell which cesareans are “unnecessary” ahead of time but it is shockingly clear when a cesarean is needed and doesn’t happen – but we don’t call those “unnecessary” vaginal deliveries.

      Being focussed on “nutrition and love” will not save you from the cruel whims of nature – to think otherwise is foolish.

      Lastly, yes birth is a natural process. Death is also a natural process. A process being natural does not mean that it does not benefit from intervention

  • figmentflyer

    Can we actually have some statistics with this editorial. Really, if you think it is that dangerous then lets look at it from a risk stand point not just a few examples. If you use this logic we should stop growing peanuts because people die from peaunut allergies. Since you are a MD, you make a living off of the medical industry, thus the more intervention the more “business” you have. I was told by my OB that if he didn’t deliver my baby by morning he would get fired. Thus I was forced into an unwanted C-section. Your type of doctor is exactly why I am looking at different options.

    • EDIT: Oh wait I misread it. That sounds terrible. Get a new OB.

  • barefootsage

    Your page is truly lacking in statistical wealth. Did you know that the American obstetrical statistics are far behind that of most other countries, and that there is absolutely no need for the C-section rate to be more than 1-2% in many, many other parts of the world? Would the woman whom you speak of have died if she wouldn’t have had her (most likely) unnecessary C-sections in the first place? The answer is, probably not. Doctors like you, who probably section more than 70% of the time (what is your stat- 85%? more? I would love to know!) are the ones putting women’s lives at risk, and I applaud the brave women who recognize the abusive nature of the unnecessary interventions and seek a peaceful alternative. The risk of uterine rupture is severely increased by the single uterine suture which you probably use as well, don’t you? Did you know that a double uterine suture is a safer alternative? You probably don’t have time to sew your patients up well, what with all the midwife bashing and misinformation-sharing you find the time for. It is people like you put the risk in a VBAC, an HBAC and even a normal first birth. Why don’t you read some Ina May? I’d better money her stats and safe births far outweigh yours!

  • Thalia

    I think you are cruel and advocate I the medicine practice and don’t actually care how your actions effect the mothers and babies. Doctors like you are the Cre reason home births are on the raise because women are sick of beening told how to labor! Also you say a complication of a VBAC you a medicated rushed one!

    • An Actual Attorney

      Is English your first language?

      • Agra

        Who cares if it is her first language or not. You know exactly what she is saying!

        • An Actual Attorney

          Actually, I don’t.

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