But the baby’s heartrate was fine right before it dropped nearly dead into the homebirth midwife’s hands

Hand of a  doctor with oximeter sensor

I am angry.

Why? Yet another baby has been placed at risk of significant brain damage and possible death because the clueless homebirth midwives didn’t understand how to diagnose fetal distress.

The story of baby Thaddeus-James is depressingly familiar:

… Our son was born floppy and unresponsive just after noon today. Throughout the birth his heart tones were good for the most part, although there were certain positions he didn’t seem to cope well with. It appears that there was a trauma in the last few moments–perhaps cord related. Full CPR was initiated practically immediately by my two wonderful midwives. He didn’t respond until about 20+ minutes into resuscitation…

And, as we’ve come to expect, the mother believes the midwives, the ones who actually bear responsibility for failing to anticipate this disaster, are just awesome:

His heart rate was checked very frequently, and the last check was 2-3 minutes before birth and still strong and in the normal range. It was with Doppler, so we could all hear it. After that, we lost it for those last few minutes, so that was when the abruption likely occurred. I am now praising God that our placenta stayed attached as long as it did. That He gave me wonderful health care providers who immediately jumped into action and saved my son’s life. For the tray I bought at a bargain store that ended up being used as a firm surface to put him on for the chest compressions. For the emergency responders who didn’t give up on my son and rushed him to safety. For living in a time and place with amazing medical care…

That’s right. We live in a time of amazing medical care, yet homebirth advocates continue to deprive their babies of this care until AFTER they are nearly dead and their brains have been permanently injured.

Why would a baby fall nearly dead into a clueless homebirth midwife’s hands?

The mother insists:

… [T]he most likely cause of the acute trauma that occurred in the last moments of his birth was a placental abruption (premature separation of the placenta).

That, not to put to fine a point on it, is bullshit.

Let’s leave aside for the moment the fact that the mother had NO signs of placental abruption. Babies do not go from fine one moment and nearly dead the next. It takes a long time, sometimes hours, for a baby to die of an abruption.

But you know what does cause a baby to have an excellent heartrate and then drop dead or nearly so into the midwife’s hands? A clueless homebirth midwife who thinks that fetal distress inevitably produces a bradycardia (low heart rate).

As I’ve explained in the past, the fetal heartrate monitor provides much more information than listening to the heartrate.

For example, this tracing shows a baby in serious trouble:

late decellerations

Surprised? You might be if you thought that a fetal heart rate tracing supplied the same information as intermittent auscultation (listening) with a doppler. But electronic fetal monitoring provides a wealth of information that cannot be obtained by listening, and that allows for a more comprehensive view of fetal well being.

This is a tracing with limited beat to beat variability and subtle late decelerations.

Notice what you don’t see:

You don’t see a bradycardia, a sustained period of abnormally low heart rate. That’s because bradycardia is often a terminal event. Most babies can tolerate long periods of significant oxygen deprivation before they die, and they may not have any bradycardias until immediately before death. On this tracing, there is never a single moment when the heart rate is outside of the normal range, but the baby is nonetheless suffering from serious oxygen deprivation.

This is almost certainly what is happening in hours before a dead or nearly dead baby drops into a homebirth midwife’s hands. The midwife may be intermittently listening to the baby’s heart rate, but unless she is listening for long enough AND frequently enough AND exactly at the right times AND can distinguish subtle changes in heart rate, she will be blissfully unaware that a baby is dying right in front of her.

Homebirth advocates and their midwives who insist that the baby’s heart rate was “fine” until just before delivery are completely wrong. The baby’s heart rate was not fine; they just couldn’t tell what was happening because they only listened intermittently.

And because they couldn’t tell, the baby pays a hideous price.

Baby Thaddeus-James received state of the art medical care, including cooling his brain to reduce brain damage. He was recently warmed up.

Despite the blessing of getting to hold him 3 times today, there appears to be a significant set-back tonight, as it looks now like Thaddeus-James may be having seizures. We are all very concerned about him. Please pray for him…

Seizures indicate the likelihood of significant brain damage, brain damage that didn’t have to happen and almost certainly would not have happened in a hospital, because:

  1. The signs of oxygen deprivation would likely have been diagnosed with electronic fetal monitoring.
  2. A C-section or vacuum might have been recommended to prevent further oxygen deprivation.
  3. A team of resuscitations experts would have been standing by to perform immediate advanced resuscitation with intubation.
  4. An additional therapy could have been initiated sooner, instead of waiting for transfer to the hospital and hospital evaluation, all of which takes precious minutes. During those minutes the baby’s injured brain continues to swell, and brain damage may actually increase over that present at birth.

Thaddeus-James’ mother is right about one thing though. We live in do live in a time and place with amazing medical care. Too bad Thaddeus-James didn’t have immediate access to it because his parents chose homebirth.