Postdates + long labor + CPM = dead baby

The whole “trust birth” thing continues to work out very poorly for homebirth midwives, the mothers they serve, and most of all the babies who die preventable deaths because of their lack of education and training.

At this point, it appears that homebirth death stories are becoming so common that mothers report on them without anger and even without surprise. Consider the homebirth death that occurred yesterday in the Santa Cruz area under the care of “Rebecca, CPM.”

The mother was not sure of her due data, but believed it to be sometime in late August or early September. So this baby was postdates, but as we know “babies aren’t library books do on a certain date;” we just have to trust birth.

And the labor was extremely long, beginning at 1 AM, progressing to 3 cm 18 hours later. That falls within the definition of prodromal labor, but progress continued to be extremely slow. She was 5 cm at 3 PM and 9 CM at 7 AM the next morning. In other words, it took 6 hours to go from 3 to 5 cm, and was only 9 cm 16 hours after that. Fortunately, they weren’t in the hospital where doctors would have overreacted and probably performed a C-section nearly 12 hours earlier. No, no C-section for them. They were trusting birth.

At that point, though, the CPM’s “trust” began to flag. According to the mother:

Around 7am Rebecca told us that we needed to go into the hospital. Although we were getting the heart beat it was in a hard place to get (very low near my left hip.)

As Rebecca almost certainly understood, the baby’s position was not low enough for the heartbeat to be heard right above the hip. She probably suspected that she had been listening to the mother’s heart beat, not the baby’s. Mom and Dad headed off to the hospital, but, curiously, Rebecca did not accompany them.

Even though she was anxious to get far away from what she suspected was an utter disaster, she had the decency to call the hospital and explain that she was unsure about the baby’s heart rate. Though she never bothered to inform the parents, the hospital staff knew they had an emergency on their hands.

Once we got to the hospital, we were rushed into a room right away. Rebecca had called and let them know why we were coming in. The nurse had trouble getting the baby’s heart beat on the external monitor. The doctor came in to break my water bag and do an internal monitor. She broke my water bag and said, “Meconium thick.” This was my first idea that something was wrong. Then she put in the internal monitor. There wasn’t a heartbeat. I knew then that our baby had died. Of course they checked to make sure everything was plugged in, and got an ultrasound, and a second ultrasound. Then the doctor turned to us and told us that our baby had died…

At some point during the 54 hours of labor, the baby stopped getting adequate oxygen. The baby expelled meconium repeatedly, suggesting that she suffered for hours. An electronic fetal monitor would have made it clear that the baby was oxygen deprived, but they didn’t want that, because they were trusting birth. As is all too common at homebirth, the baby died after a long struggle and the CPM not only had no idea that the baby was struggling, but she had no idea that the baby was dead.

To summarize, a postdates mother was allowed to labor for 54 hours with grossly inadequate monitoring of the baby and the baby died a completely preventable death. Why? Because the parents trusted a CPM, an ignorant, undereducated, undertrained, self proclaimed “midwife” who blithely sat by completely clueless while a baby’s life ebbed away.

The mother’s ordeal was not over; she continued with her plan for a “natural” birth, though she did agree to pitocin. The baby was very large and the shoulders got stuck. Since the baby was already dead, there was no urgency, but the fact that it took doctors 40 minutes to extricate her is a testament to the size of the baby.

The mother is still in shock (it appears to have happened within the past few hours) and shows no awareness that this could have been avoided entirely. This morning, instead of nursing her precious daughter, she is planning a funeral. The CPM who presided over this preventable disaster is nowhere to be found.

Trust birth?

Sure, as long as you aren’t concerned about whether your baby is born alive or dead.

  • linda karpiscak

    As for babies oxygen levels being low in utero because of “second hand oxygen”, babies have a higher hematocrit than the rest of us and have fetal hemaglobin. Both have a higher oxygen carrying capacity than our blood, so they can basically “grab” more oxygen from the maternal circulation.

    • Nick Sanders

      Why are you arguing with a five year old comment?

  • linda karpiscak

    As a neonatal nurse, I’ve seen way too many things go unexpectedly wrong during the labor of low risk Moms & babies. Yes, home birth was practiced long before hospitals even existed, but what no one wants to talk about is that the maternal and infant death rates were very high back then. So high, that in some cultures, babies weren’t even named for a period of time after their births because they never knew if a baby was going to live or not.