15th and 16th homebirth deaths I have reported on this year

An quick review of my blog posts so far in 2012 shows that I have written about 14 separate confirmed homebirth deaths attended by American homebirth midwives this year.  That doesn’t include additional homebirth deaths that I have been told about but have not yet been able to confirm.

To put it in perspective, American homebirth midwives (non-nurse midwives) attend approximately 10,000 homebirths each year. The death rate for comparable risk birth in a hospital is 0.4/1000, which means we should expect approximately 4 deaths each year. Today I’m reporting on the 15th and 16th homebirth deaths. The year is not over and already the homebirth death toll is 300% higher than it should be.

Death #15

Michael’s birth and death

Background:

Both of my previous pregnancies had been cesarean deliveries and not experiencing natural labor was something that left me feeling like I was missing something. It is very hard to explain to someone who hasn’t missed out on labor and delivery but it was upsetting to me to feel that I missed out on such a beautiful, natural experience. I wanted to be the first person to touch my baby, I wanted him immediately bought up to my chest so I could take in all of his beautiful features, I wanted to be able to nurse as soon as the baby was ready, I wanted my baby’s cord to have a chance to stop pulsating before being clamped to be cut, I didn’t want to be pressured into unnecessary procedures, I wanted a peaceful, lovely birth experience and I felt that the only way to get that was to have a home birth…

In March, I met with a wonderful midwife, Jen, who had shared my belief in my body’s ability to naturally birth my baby and we agreed that I was a great candidate for a successful hba2c*…

Birth:

At around 12:50, Jen had asked if I had wanted her to check me. I said yes and she told me I was now 100% effaced and 9.5 cm dilated and my water bag was still intact and bulging. Since I was so far along, she had asked if I wanted her to rupture my waters. She went over the benefits and risks and I decided that after I got through a few more contractions, I did want her to. When she had ruptured the water bag, she let me know that the amniotic fluid had meconium in it and that we would start to monitor the baby more closely. She immediately checked his heart rate and it was in the 130 range, just as it had been during the entire pregnancy and labor. A few minutes later she had checked it again and had a hard time getting a good reading (I think it was in the 90’s). My husband had gotten me 2 glasses of fruit juice in hopes that getting some fluid in would help us get a better reading. After Jen checked again and didn’t get a good reading, she had told me that it was time to transfer to the hospital…

At around 4:30, I was finally wheeled into the OR to prepare for surgery. It was so hard to stay still while the spinal was placed since I was still having back to back contractions but once it was in, my whole body seemed to relax and I just began to focus on the excitement of seeing my sweet boy. They bought my husband in once things were ready for the section and we talked about everything that had happened up until that point. I noticed almost immediately that things were very different this time compared to my previous two C-sections but I had attributed it to the fact that they were planned and this one was an emergency. With my first 2 sections, they had the baby out within just a few minutes of making the cut. This time, it took almost a half hour for them to deliver Michael, at 5:01 PM…

With the first 2, they had told my husband to stand up and look as they were pulling out the baby. This time, he wasn’t given the go ahead to stand up and look at all. The first 2 times, I had heard my babies begin to cry almost immediately of being pulled out. This time, I heard no noise at all. I had mentioned to my husband that I was worried that I hadn’t heard the baby and I had asked those working around me why he wasn’t crying and if he was okay but no one was giving me any answers. My husband had looked down under the operating table and said “oh wow, there is a lot of blood.” Right after this, someone had come up to him and told him that he needed to go and wait in the waiting room.

Instantly, panic had taken over and all I could think about and say over and over to myself was “oh my baby, what is wrong with my baby?” I knew I was having complications but my only concern was my baby and his health. I didn’t realize the seriousness of what was going on with me until I overheard the Dr mention “uterus rupture” and “full hysterectomy” several times…

Once they had finished with me and I had asked about my baby, they had told me that Michael had breathed in meconium and he needed help breathing on his own. They were going to need to transfer him to Danville NICU, a town 2 hours away from our home, because they were better able to give him the treatment he had needed.

Michael’s treatment:

Just before 1 AM, I was awoken by the nurse. She let me know that the NICU was trying to get in touch with me to give me an update on the baby. I had spoken to the nurses taking care of Michael several times before this point and I knew that it had to be serious for them to be trying to get in touch with me in the middle of the night. I called them back and the nurse had asked if my husband was with me. Immediately, I knew that I was about to get devastating news. I said “no, he went home with the 2 kids tonight.” Then she asked if any family member was there with me. When I said no, she asked if a nurse was there. I said yes, there is a nurse here and she had told me that it would be a good idea to get there as soon as possible. Michael had coded two times and he wasn’t doing well, he might not make it to the morning. At that moment, I could not breathe. They must be wrong. My baby would be fine, all this time I was told that he was very sick and he would get worse before he got better but never had the thought of my baby dying crossed my mind.

…We spent the hour and a half ride praying that our baby would hang on until we got there to say goodbye to him. We did a lot of crying and thinking about how we would possibly be able to explain to our two children where the little brother they waited and looked forward to for 10 months had gone. We asked God why this was happening to us and tried to imagine how we could possibly breathe one breath, live one moment without our Michael…

This was the first time since he was born that either one of us had the chance to actually see our son for more than a moment or two. As soon as I saw my little angel, I began sobbing. Michael looked so sick. He was swollen, hooked up to so many machines and on so many medications. The two nurses who were working with him that night were incredibly helpful and explained our baby’s condition the best they could. They had given us a picture of when Michael was baptized and asked if we had wanted anymore taken.

Shortly thereafter, Michael died … a needless death of terrible suffering that could easily have been prevented by an elective C-section.

Death #16

Kaiya’s birth and death

At 7pm the contractions were regular and beginning to get intense so we called the midwife. Bryan filled the birth pool and I did the majority of my labor in there from that point. I would strongly recommend a water birth. You don’t have to give birth in the pool, but the water feels AMAZING, it eases the pain of the contractions and makes them more bearable)…

Kate, our midwife, arrived shortly after we called her and she was also amazing. I wouldn’t have wanted to go through this process with anyone else. She made all the right decisions and we are both so very grateful we had her… She checked Kaiya’s heart tones every hour and then around midnight called her student, Michelle, to come because we all thought birth was soon, I had finished transition.

Around 3am I got out of the pool for a bathroom break and was sitting in there through a contraction when Kate came in because it was time to check heart tones. That’s when they were gone, and Kate rushed me into bed to check from a different position.

She couldn’t get a read at all and called Bryan and Michelle in. She had Bryan call 911 and Michelle assist her with me. I could sense her panic but she was incredible. I can’t describe her demeanor from this point on. It was urgent but never led me believe it was over. I couldn’t have made it through had I known that. She told me to start pushing and had her hands on Kaiya’s head the whole time we waited for the ambulance to arrive, that’s how close she was. Michelle was straddling me from the top, pushing down on my belly to try to help push her out. I pushed with and without contractions. It was the most exhausting thing I’ve ever done…

The hospital is 10 minutes from our house without the advantage of an ambulance. I’m sure we made excellent time because we were in an ambulance and it was 3am, so no traffic…

We got into the room and God must have cleared their floor for me because there were about seven people working in my room. Now, a big reason I chose a home birth was because I believe that God designed your body to give birth. So many things about pregnancy, labor, and birth are miraculous and all the systems He put in place are amazing and can be trusted. I still believe that. In contrast, I believed that hospitals are if something goes wrong. They are if you are sick, injured or dying, and pregnancy doesn’t fit into any of those categories. Then, at the end of my pregnancy when I realized the hospital was a real option I became aware that I was terrified of hospitals. That’s the last place I’d ever want to be for giving birth! I was afraid they’d make me take petocin and stress the baby, that they would push pain medicine which I hate and absolutely didn’t want in my child’s system, and they would be cold and factory like in their treatment of my family and I. I did not want to go to the hospital. Aside from a c-section, the hospital experience in itself was my biggest fear of pregnancy and it came on so strong in the last few weeks it was overwhelming.

Fortunately, my experience at the hospital was the exact opposite of my expectations. The Labor and Delivery staff at Genesys Regional Medical Center, every single person we met, was amazing. I am so grateful for everyone that God put in our lives to help us through this. Because of this experience, I will never look at the hospital in the same way again. The compassion, love, and care we were given was honorable and necessary for not only my physical health, but also my mental health. I still cannot get over the sweetness and humanity of the staff.

The first doctor came in and checked for Kaiya’s heart tones and couldn’t find anything but decided to call another doctor to check. So for the second time, I knew it wasn’t over. I just knew that she was fine, all I had to do was get her out. It was that simple. The second doctor came in and checked and also couldn’t find anything. I was more concerned at that point, but again was certain that she was fine. I asked him if she came out and her heart really had stopped if they could fix it. He shook his head but I didn’t believe him. I KNEW she was fine, all I had to do was get her out. If I didn’t have that mental state, there is no way I could have continued…

Finally, after what seemed like awhile her head came out and I saw her for the first time, and that’s when it finally hit me that I was wrong and everyone else was right. It was the worst moment of my life…

Kaiya also died a needless, senseless, preventable death, but her mother is clinging to denial.

What happened with Kaiya could not have been prevented, even if I had chosen the hospital route from the very beginning. Nothing about this was due to the home birth setting…

It had everything to do with the birth setting and the incompetent midwife. Electronic fetal monitoring almost certainly would have picked up the baby’s distress long before the baby’s heart stopped. Even remotely competent auscultation might have prevented this disaster. Checking the heart rate once an hour is malpractice, even by the lax standards of homebirth midwifery. And immediate C-section could have saved this baby’s life, but the decision to give birth at home, the decision to employ a poorly educated poorly trained homebirth midwife, and the transfer time to the hospital was the equivalent of a death sentence. Kaiya died though she easily could have been saved.

 

*This is an oxymoron. There is no such thing as a great candidate for an HBA2C. Any attempt at VBAC after 2 C-sections should ONLY occur in a hospital.

  • Elsie

    Is there something I’m missing here? Both of these births occurred in the hospital. The midwives facilitated the transport from home to hospital when trouble was perceived. That is responsible behavior.
    Also, many women wait till active labor to come to the hospital, women who intend to birth in the hospital.
    Fetal deaths occur all the time in women who intend to birth in the hospital, women with oodles of prenatal visits and ultrasound scans. Twenty-nine weeks, 37 weeks, 40 weeks–and we all feel powerless in the face of them.
    I’m an L&D RN and it seems Dr. Tuteur has a vendetta.

    • Amy Tuteur, MD

      Yes, there’s several things you’re missing. I bet if you think hard enough you’ll figure it out since you are an L&D nurse.

      • Captain Obvious

        Doubt she is really a L&D nurse.

      • Guest

        Dear Amy, I know Micheals birth story. I know her midwife, I know her doula, and I know the mother. I read the mothers birth story personally in its original publication. You completely left out the part about her OB in the HOSPITAL telling her to wait on a c/s because michaels heart rate was fine again when she arrived at the hospital. And thw part when she asked the Dr repeatedly for a section and he didn’t see the need for it. That’s when she finally got rolled into the OR. Not beacuse of a late transfer. Because of a Dr who didn’t see the problem that the midwife had caught early on at home. So tell me, where did the preventable death occur?

        • Amy Tuteur, MD

          It occurred when she decided to have a homebirth instead of an elective repeat C-section.

          • Guest

            And do you support VBA2C in a hospital?

          • Young CC Prof

            Whether hospital VBA2C is a good idea depends on the mother, and is determined by the board-certified obstetrician who reviews her case in detail a few weeks before the due date and considers all factors.

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  • http://www.facebook.com/kathleen.neely Kathleen Elizabeth Neely

    make that 3 I was into being a midwife too, I thought it would be really cool and help people. Dr. Amy opened my eyes. Thank you!!

  • http://www.facebook.com/kathleen.neely Kathleen Elizabeth Neely

    yes and I really feel bad about those mentrual cramps Im not having since my hysterectomy. eyes roll sigh…

  • http://www.facebook.com/kathleen.neely Kathleen Elizabeth Neely

    no, no they cant, I had a miscarriage at 12 weeks and it would not come out. literally I bled and bled for 3 weeks, no fetus, no nothing. Finally had to have a D&C.After they knocked me out cold.

  • http://www.facebook.com/kathleen.neely Kathleen Elizabeth Neely

    my 2nd C section was awesome, fun, cool ,painless ( until the epi wore off) I wouldn’t have done anything differently… Thank you to the Doctor and nurses who did a fabulous job!!
    also, Genessys regional medical Center has a wonderful reputation!! as does every hospital iin that area, I had both of my kids there.

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