Yet another mother dies at homebirth

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At the end of December I wrote about 22 children left motherless when 7 different women died at homebirth. I wasn’t aware that an additional 2 mothers died in December leaving 11 more children motherless.

Two weeks ago, I wrote about one of the maternal deaths. A mother in Texas died after a postpartum transfer from homebirth. The baby was born lifeless but surived after cooling therapy to mitigate brain damage from lack of oxygen at birth. The mother died despite days of heroic efforts to save her life at the hospital.

Yesterday I learned about another mother, also from Texas, who died 9 days before the first death.

According to her husband:

Dec 11th 2014 my wife texted me and said that it was time for me to come home for the birth of our 8th child. This was our 7th homebirth, the other 6 an amazing success.

She had no reason to suspect that she would suffer a life threatening complication, amniotic fluid embolus, but she did. Her labor was proceeding normally, and then.

The midwife checked her and the baby and it was time to get her to push. As the pain got worse she looked at me and said it was so hard. I tried to comfort her as best I could. Then she passed out in the tub.

When seconds counted, they were many minutes away from help.

We called 911 and got her out of the tub onto the bed. We could see that she wasn’t breathing so we tried CPR. She kind of came to a little bit and was trying to push the baby out with all she had while not being able to breath. She then passed out again never to awaken.

On arrival at the hospital:

…[They] did an emergency C section in the ER. They then struggled to keep her alive as I sat outside the curtain more afraid than I had ever been in my entire life before. They took Lilly to the NICU to try to save her but to no avail.

The mother never recovered despite intensive treatment.

After 5 grueling weeks of watching her almost bite through her lip when she would have seizure like episodes and seeing her kept alive by machines, she died on my 6 year old’s birthday Jan 17th.

Would she have survived had she been in a hospital? That’s hard to say because amniotic fluid embolus has a 50% mortality rate. But we can be sure that she would have had a better chance at survival and the baby would have had a much better chance with an immediate C-section.

I’m not sure if things would have been different if we would have had a hospital birth, but there is a chance I would be holding a sweet little girl and perhaps snuggled next to my wife if we would have known more about AFE. This is why we are all posting our stories, donating our time, and money. Lord willing we might be able to save one baby or one momma and it will all be worth it.

Now 33 children have been left motherless by the deaths of 9 different mothers at homebirth.

Thinking about homebirth? Think again.

Think about leaving your children motherless and their father struggling to cope.

This father is warning you. Don’t ignore his plea.

  • FHoesing

    In all fairness, this article is quite biased, as if death while giving birth never happens in hospitals?

    From the Washington Post: The researchers estimated that 18.5 mothers died for every 100,000 births in the U.S. in 2013, a total of almost 800 deaths.That is more than double the maternal mortality rate in Saudi Arabia and Canada, and more than triple the rate in the United Kingdom.

    • Sullivan ThePoop

      Hmmm … Saudi Arabia reports their death rate at 16 per 100,000. So, not double at all. Also, 8×3 is 24. I’m just saying.

    • Amy Tuteur, MD
    • Dr Kitty

      Questions:
      Is a young, healthy woman more likely to die after giving birth at home, or in hospital?

      Is a very unwell female more or less likely to survive to adulthood , conceive a pregnancy and carry it to term in the USA or Saudi Arabia?

      • fiftyfifty1

        Exactly. Last year I did a physical on a young woman who was born with transposition of the great vessels who was debating the pros and cons of trying to conceive.

    • Bombshellrisa

      Please keep reading, Dr Amy posts about injuries and deaths in both hospital and out of hospital settings.
      I try not to get annoyed when yet another person says “babies die in hospitals too”. It sounds like someone arguing it’s safe to forgo wearing a helmet because people die while driving cars too.

    • The Bofa on the Sofa

      More people die in sober driving car accidents than die in drunk driving car accidents.

      Yet we still obsess over the dangers of drinking and driving.

  • sdsures

    How recent is the application of cooling therapy for babies who need it?

    • TsuDhoNimh

      It started in the late 1990s … it’s not exactly new.

      By reducing temp you reduce O2 requirements.

      • sdsures

        Reason I asked is because I was a preemie in 1981. Yep, cooling is good for minimizing brain damage.

  • Daleth

    An amniotic fluid embolism was my nightmare. I actually asked the docs to please not exteriorize my uterus during the c-section, because I’d seen a study that showed a correlation between that and AFE’s. They kindly complied even though their standard procedure was to exteriorize.

    That poor family. I can actually understand choosing a homebirth again once you’ve had six of them and they’ve gone well. But this just goes to show how you never know, and so it’s best to be someplace where they can help you (i.e., a hospital).

  • Guesteleh

    OT: Humans of New York is profiling a man who seems to have lost his wife to HELLP syndrome. Compelling and very sad reading: https://www.facebook.com/humansofnewyork

    • Daleth

      Oh my god, that’s so so so so so so sad.

      Here’s a link to the last in the series about them:
      (function(d, s, id) { var js, fjs = d.getElementsByTagName(s)[0]; if (d.getElementById(id)) return; js = d.createElement(s); js.id = id; js.src = “//connect.facebook.net/en_US/sdk.js#xfbml=1&version=v2.3”; fjs.parentNode.insertBefore(js, fjs);}(document, ‘script’, ‘facebook-jssdk’));

      “The birth went fine. Teela was born early so they took her and put her behind glass under a blue light. For the next…Posted by Humans of New York on Tuesday, March 31, 2015

    • Liz Leyden
  • Not sure how to take this.

    • Cobalt

      I know that if someone had told me “God chose this” after I lost my child, I would have committed physical violence against them. God must have wanted me to do it, if He allowed them to say something like that.

      And, yeah, AFE is only 50% survivable in the hospital for the mom, but those are better odds than at home. They might well BOTH be alive if they had actual immediate medical treatment.

      “This choice you made, that drastically reduced your wife and child’s odds of survival, couldn’t possibly be to blame for their deaths” is a heaping load of crap.

      • Mishimoo

        Honestly, it’s a huge part of why I stopped going to church. Being 17 and having lost a much-wanted baby to a miscarriage, then faced with all of these smug, self-righteous ‘pro-lifers’ that informed me it was God’s will and God’s perfect plan for my life instead of grieving REALLY hurt. My condolences to this family and I truly hope that they find peace and support at their church.

        • araikwao

          Why are Christians so good at forgetting about compassion – Jesus was pretty big on compassion. Grrr. I’m a Christian, and Christians really annoy me sometimes!

          • Mishimoo

            Same here!! It’s really frustrating and rather sad.

          • SporkParade

            I think people are just really dumb when it comes to misfortune. They know they are comforted by believing that tragedies happen for a reason, so they assume that that’s a comforting thing to tell someone who is actively mourning when it’s actually a patronizing jerk thing to say.

          • Mac Sherbert

            Years ago I read that just saying “I’m sorry” is the best thing to say to someone who has suffered a loss. I’ve stuck with that line for many years now. It really is all you need to say…if they want more they’ll start talking and you go from there.

          • Something From Nothing

            What do you expect from a religion that encourages people to cast all of their sins on Jesus, who died to save them all? Vicarious redemption. Scapegoat. Push the blame on someone else. It’s sickness. How does God want them to get a promotion at work, while senselessly killing a woman with seven children? Such bullshit.

          • araikwao

            That’s just an example of the corruptness of people, not something to trash God about. The prospect of someone perfect being willing and able to wash away everything that I’ve ever done and make me worthy in the sight of an otherwise terrifyingly perfect God is humbling and freeing, but not something that excuses me from consequences or makes blaming or shaming another person for my own crap an acceptable behaviour.
            Ugh that is probably an inadequate response. But blaming behaviour that sounds more characteristic of a personality disorder on God is unreasonable.

          • Something From Nothing

            How does it not excuse you from consequences? Is it not true that you can repent your life time of sin on your death bed, accept Jesus as your personal savior and then you’re all good? It absolutely is an example of vicarious redemption/ scapegoating no matter how you slice it. And I find it repugnant. And how is God perfect?

          • Mishimoo

            This is something that araikwao believes in which brings happiness into their life. Who are you to be so negative about their chosen beliefs when they are using them to help others instead of harming other people?

          • Stacy48918

            I have to agree with Something in that – while araikwao might live a very good, compassionate life…there is something about those beliefs in particular that can’t be escaped.

            A friend of mine is a conservative Christian, but nowhere near as extreme as my husband or any of the churches we belonged to. She is friendly, kind, outgoing and really a very lovely person.

            But she believes that if my son or daughter do not accept Jesus then they will burn in hell for all eternity. That is a key Christian belief, no matter how nice the person that holds it. And I have a problem with that…

            I like “nice” Christians…but some Christian beliefs are still…concerning.

          • Mishimoo

            Ugh, yeah. That bit bugs me too because it really doesn’t fit the concept of a loving deity. It’s something that I’ve mused over and I really don’t have a good answer. Since I don’t have a good answer, I don’t scare people into sharing my beliefs in order to avoid something that may or may not exist. (I also think that scaring children into believing something is very wrong)

          • Stacy48918

            Recently this same friend asked me about my beliefs. She knows I’m getting divorced (though she had to point out that “I do not condone divorce”). I told her I’m an atheist now. She replied that I am taking a gamble with my life and eternity and that of my children too. Like you said – what kind of a “loving” God is that? When you put it like that…it’s not really a great advertising campaign. Anyway…

          • Mishimoo

            Ouch! The smug rolling off that?! I’m amazed that you maintained your composure and still call her a friend. And no, it’s not a great advertising campaign nor is she a good salesperson.

          • Stacy48918

            Oh I wrote a pretty terse reply email. At this point in my life I really need supportive people around me. And to have someone that’s only been married barely a year preaching to me about not “condoning divorce”. Yea, no thanks.

            I told her the same for both things (religion and divorce) – you’re free to believe what you want. But you may find that if you stick to that position without being able to see the PEOPLE involved, you may find yourself holding your ground on divorce, but losing me as a friend.

            That was Sunday, haven’t heard back from her.

          • Mishimoo

            *facepalms* Wooow. Barely a year? That’s still in the honeymoon stage, it’s far to early to predict how things will turn out.

            Something I’ve noticed – the people who are most vehemently against divorce for religious reasons seem to be the ones that end up with one, but theirs is the only righteous one. (For example: My parents divorce finalised last Saturday)

          • Stacy48918

            Barely a year and haven’t even had their first kid yet (due at the end of this month). Gimme a break.

          • Liz Leyden

            “Accept Jesus or burn in Hell” is not a universal Christian belief. I was raised Roman Catholic by a very devout mother and 13 years of Catholic school. We were definitely NOT taught “accept Jesus or burn in hell.” In my experience, Roman Catholics don’t really do personal relationships with Jesus. That may be the reason some Christian denominations don’t consider Catholics to be Christians.

          • Roadstergal

            As a from-the-cradle atheist, one of the few Christians I can read is the Slacktivist – he does have some interesting blogs on the lack of biblical support for the concept of a hell sinners burn in.

            But yes, the question of theodicy is one I’ve never had addressed by a theist in a way that doesn’t leave me feeling utterly unconvinced or creeped out. Sometimes both.

          • Something From Nothing

            Who am I? I’m someone with an opinion that is valid, even if it is critical of someone’s chosen beliefs. Am I not allowed to express that opinion? I find it incredibly insulting when people brush things off as “gods will”. How trite. And how can anyone say loving God? Starving and diseased children? Look at the incredible suffering in the world and explain to me how your idea of God as loving fits that picture. I was told when I was a child that God is loving. I didn’t believe it then and I sure don’t believe it now.

          • Mishimoo

            Yes, your view is valid. So is araikwao’s, and she was empathising with me. It was rather rude to come in on an old discussion, apparently only to insult someone based on their chosen beliefs when they were being kind. It’s not exactly great advertising for atheism/antitheism.

          • Stacy48918

            I can totally agree with this too…though now I’ve jumped in as well. Tell me to shove off and I’ll go to bed. 😛

          • Mishimoo

            Hahaha! I don’t mind in the slightest, you’re coming out of a similar household to me, and I get it. I’ve been there, I’ve questioned those beliefs, I have read so many things, tried to be objective, and now I tend to be that annoying person calling out people on my fb for preaching.

            That is to say: I have absolutely no problems discussing religion with you because we respect each others right to choose what we believe in, and understand the responsibilities thereof.

          • Stacy48918

            I recently shared an article on my Facebook about an abortion clinic with a spa-like environment. Some “churchy” people replied with nothing but a list of Bible verses. I wrote back that they’re welcome to their opinion, but everyday good women have abortions. “I am one of them and I have no regrets.”

            Believe what you want, but keep it off my FB.

            Same issue though – holding to a “position” (abortion, divorce) but being unable to see the people involved.

          • Mishimoo

            Oh goodness, that is awful! Imagine the other people reading that who have had abortions? I’m glad you don’t regret having an abortion, and I hope that the verses didn’t get to you.

          • Stacy48918

            Didn’t get to me. But yea, no way was I going to leave that on my FB without commenting and I didn’t want to just delete it.

            What got to me was trying to write something not completely bitchy. What I wanted to say was “well god aborted 3 of my babies, so maybe he could answer to me for that first”….but I didn’t. 😛

          • Mishimoo

            Good call! The only problem is then the lecture about rebellion/being angry with God starts…and makes me glad that I’m an adult who can opt out of hearing that.

            I recently called out a pro-lifer for once again saying that she’d prayed for her daughter-in-law and grand-foetus to die while they were in an induced coma. She didn’t appreciate all the bible verses.

          • Stacy48918

            Yes well, if they had replied back to my “I do not regret” post with anything other than a gracious apology I would have sent the bitch comment, then blocked them. They can keep their lectures to themselves. I don’t need that in my life TYVM. 😀

            As it is, they’ve been silent.

          • Something From Nothing

            I don’t accept that I’m being rude. How is commenting on a thread rude? Happens here all the time. Is it rude bcause you didn’t like my opinion? Is that what makes it rude? And I’m not advertising for atheism. We don’t recruit. It isn’t s belief system. I’m also a non believer in unicorns but I’m not recruiting for that either. I think it is incredibly rude to tell someone who just experienced a tragedy that it is gods will, unless you are their pastor and they have come t you to specifically hear that. And I can comment on any thread I feel like. It’s a blog. There’s a comment section. It’s for commenting. Or are there rules I’m not aware of?

          • Stacy48918

            No, you’re being a bit rude. That’s coming from an atheist that is divorcing her fundy Christian husband.

          • Something From Nothing

            Explain how I’m being rude?? I’m not nearly as rude as the regular commenters here are to people who parachute in and say daft things about birth. I think you are being extra sensitive because it’s religion and we are taught that it’s bad to criticize someone religious beliefs. If I said something rude to a parachuter you’d probably hit the like key. I really don’t see rude in what I said. Sorry.

          • Stacy48918

            You parachuted in just to rant about religion. While your points might be right, it was out of the blue and soapboxy for no reason. On a week old thread. That’s just trying to make a point, not have a discussion.

          • Mishimoo

            It’s rude because you’re tearing someone down for being kind.

            “I think it is incredibly rude to tell someone who just experienced a tragedy that it is gods will, unless you are their pastor and they have come t you to specifically hear that” <- that, right there? That is what she was empathising with me about.

          • Something From Nothing

            Mmmmmm Don’t get it. Sorry. My rude radar must be off.

          • Stacy48918

            Please understand Mishimoo, I mean this in the gentlest of prodding…I doubt you would feel similarly (“this just brings happiness”) for someone espousing homebirth views. Having a homebirth makes many women “feel happy”, and most of the time it turns out ok…but having chosen that belief doesn’t make them immune to criticism.

            I hope that comparison makes sense…maybe I’m just pulling it out of my ass…

            My ultimate point is that religious views tend to get a “free pass” just because they make someone “happy”. We don’t allow that in most other arenas of life. What makes one individual “happy” may actually be dark or harmful in other aspects.

          • Mishimoo

            No, it absolutely makes sense. Religion doesn’t get a free pass from me, I’m usually the first to point out the problematic history of mine. I just don’t see the point in tearing people down when they’re being empathetic and a good ambassador for their religion.

          • Stacy48918

            Agreed.

          • Something From Nothing

            And, for the recod, my intention was not to tear anyone down. For goodness sakes, this blog tips people apart who say things in support of home birth but you can’t criticize religion? Why is it so taboo? You criticized Christians. I was agreeing with you.

          • Mishimoo

            I was criticising the ones that preach love, compassion and acceptance but don’t actually practise it in day-to-day life. Araikwao was demonstrating those things again, as they regularly do here.

          • araikwao

            Sorry if i wasn’t clear – I find out hard to be complete without being too rambly in these discussions. I mean that you don’t necessarily escape consequences in the world around you, say if I (hypothetically!) stole a necklace from a shop. I could ask forgiveness (and be forgiven) by God because of Jesus, but it won’t stop me from being charged with theft.
            Yes you can repent on your deathbed (I used to find this really hard to grasp), because it’s not what you do that earns you right standing with God, it’s His grace (unmerited favour) and it’s more than enough to cover a lifetime of falling short of perfection. It is hard to get past the idea that we had to do something to earn our way into God’s favour (and therefore the deathbed person mustn’t have done enough, it doesn’t seem fair etc) – but it’s not our rules, and so many things are turned on their head when it comes to the way things work in God’s kingdom. (Sorry if this is starting to sound all Christianese)
            The scapegoat thing – yes! Jesus was the scapegoat, the perfect sacrifice that all those thousands of years of offering lambs and goats (the original scapegoats) t couldn’t fix. Once and for all, no need for any more. And yet none of us deserved it. That fierce intensity of love is just phenomenal.
            And yes, God is perfect. The world is not – humans were made free to be able to love God (or not), and to make decisions. We made a decision that allowed the world to be corrupted and so we have sickness and suffering and wars and evil. But there is hope, because it’s not forever, and most of it is amenable to change and love.
            I’m sorry it’s repugnant to you. I find it mind-blowing, and it fills me with hope to know that we are loved and treasured, and it makes me want to spend the life I’ve been given on things that can make other people’s lives better, particularly those who might be disadvantaged in the world today. I want to be able to show people love that maybe the world thinks they don’t deserve, and for me that is going to continue to be in the area of healthcare (and pretty soon as a doctor). That’s not repugnant.

        • rachel

          saying to myself it is God’s will made me feel better after my miscarriage but I wouldn’t say that to anyone because I don’t know what their feelings are about God at that time… a hug works so much better than words that can hurt! so I’m glad that my dad just hugged me… I was worried he’ll say something hurtful, without meaning to ofcourse

          • Dr Kitty

            Fatalism is a coping mechanism.
            Believing something was “fated” or “meant to be” or “G-‘d’s will” or “part of a greater plan” or “the will of the Universe”- however you phrase it, what it MEANS is “this can’t be blamed on me or my choices, my actions or inactions didn’t cause this to happen”.

            Now, when you’re talking about miscarriage, which we know in almost all cases can’t be prevented and can’t be caused by anything a woman choses to do or not do, then yes, that’s a fine way of coping, if it helps you.

            Saying it specifically about the decision to HB, which reduced the chances of surviving AFE from 50% to as good as 0%…not the same thing. Not the same thing at all.

            It may be comforting to think like that, and absolve yourself from blame, but it isn’t TRUE.

            Now, sometimes it is appropriate to chose kindness over truth, but when that “kindness” is then used to justify OTHER people making dangerous choices…well, then you have to judge whether being kind and lying to the bereaved is better than being truthful and potentially saving lives.

      • araikwao

        God created people free to make their own decisions, including the foolish ones. It irks me when people blame God for something like that.

        • Mac Sherbert

          I think saying it was God’s will is people trying to take the blame from themselves. However, it really doesn’t work that way. If you do something stupid, it wasn’t God’s will for you to be stupid. All people will suffer hardships, but inflecting them on yourself does not get you bonus points.

      • sdsures

        “I know that if someone had told me “God chose this” after I lost my child, I would have committed physical violence against them.”

        So would I.

        • Kq

          Thirded

      • Liz Leyden

        The day before my daughter had heart surgery #2, the surgeon explained the procedure to my husband and me. He started with a statement about making her “God-given heart” work more efficiently, and finished with “God is great.” It took everything I had not to say “Is this the same God that gave her half a heart?”

    • Froggggggg

      I won’t comment on the religious aspect – maybe it’s something that will provide comfort to the father and it sounds like this person knows him. The “don’t second guess yourself about the homebirth, she might have died in the hospital” is exactly what I’d expect to see from the NCB crowd – so predictable. *sigh*

      • Yeah, I wasn’t sure whether it was meant as “Don’t blame yourself” or “Don’t blame homebirth”.

    • yugaya

      “even if she was in the hospital she might not have survived”.

      There was 50% chance of survival in hospital vs 0% chance of survival at home, and this idiot has the nerve to claim that the location of birth makes no difference.

      Homebirth apologists that show up to comment on homebirth loss stories are the lowest of the low, she is literally pushing her agenda over this woman’s dead body.

    • TsuDhoNimh

      So … “God nudged them” into a direction that killed a woman and her baby?

      Thank God!

    • sdsures

      That person is really SICK.

  • Oh my god, to be left with that many children to rear up on your own, and the added trauma of a kid’s birthday being his mother’s death date. How terrible for everyone.

    The father is very brave to speak up about what happened despite what I’m sure is a significant taboo. Because of the strength of church communities, he’s doubtlessly going to have to watch other families make the same risks and worry that they’ll also have a sad outcome.

  • Trixie

    My heart breaks for this family and the beautiful children who are now motherless. This mom and this baby deserved the best shot in a life threatening situation, and they didn’t get it. 2 maternal home birth deaths in one state within 10 days — it’s an outrage.

  • MrG

    Women should have homebirths because maternal mortality and cesareans in the US with 98.5% hospital birth rate are too high. When there were more homebirths 90+ years ago there were less maternal deaths?

    Wait! Did I miss anything? How come maternal mortality these days with hospital births so much lower than 90+ years ago?

    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm

  • Tragedies in maternity care are simply heart-wrenching – and when the outcome might have been different with a slightly different choice that is just awful. I get that decisions are made prospectively, not retrospectively – be I also think that we need to change the conversation around the choices that are made. Statistically low risk counts for next to nothing, when you are the person who is the statistic.

  • guest

    I just can’t with the six year old whose mother died ON HIS BIRTHDAY.

    • The Computer Ate My Nym

      I’m puzzled by that. Generally when someone is badly brain damaged but essentially stable in the ICU death comes when it is decided that the treatment is medically futile and care is withdrawn. But why would this be done on the 6 year old’s birthday? That seems…wrong. It may be that the death was due to some new issue rather than withdrawal of care, though. Poor kid, in either case.

      • guest

        Yeah, it does seem strange if it was a chosen day, but without all the medical information, who knows. I just feel so sad for that kid, and the rest of the family.

      • Bobsie

        Looking at his posts, it looks like she was transferred to a subacute facility and that they called because she had taken a turn. She had a trach and a G tube, so it wasn’t a case of pulling the machines. She also had a stillbirth years ago and a miscarriage after 7 months after a previous pregnancy and birth. That means she was pregnant with this child very quickly after the miscarriage. It was her tenth pregnancy. How sad. And how sad they didn’t realize that she was higher risk that she was. I hope his family continues to work through this pain.

  • attitude devant

    I have attended two AFEs. Both moms survived. Not because I’m so fabulous but because we had a whole team working on each of them and a great blood bank and terrific ICU. Because a midwife, doula, and apprentice are just not going to cut it. No mom with an AFE is going to survive out of hospital. Done. Over. End of story.

    • araikwao

      Yeah, I was wondering if mortality rate for AFE at home birth would be 100%…

      • Cobalt

        Supposedly Carri Chmielewski, Quiverfull homebirther, had an AFE and survived but lost the baby. Her blog, and most stories about it, have been wiped from the web, though, so I don’t know if it was really an AFE or if she went to the hospital or anything.

  • MaineJen

    My favorite part of this story is when the mother passes out in the tub, and the midwife asks the father “Has this ever happened before? Is this normal?” I had to do a double take when I read that. What a question for a midwife to be asking at such a time. They truly are “experts at normal birth…” as soon as anything becomes abnormal, they have NO idea what to do.

  • Dr Kitty

    Grand multiparity is a risk.

    People understand that when you talk about Michelle Duggar, and you point out that her last few pregnancies have been getting more and more complicated…

    They don’t get that the point at which that happens isn’t 10 or 15 births in, it is about 5.

    I remember, vividly, a lady having her 9th baby. She’d literally had every kind of labour and vaginal delivery- from prolonged labour and forceps with her first, to precipitous labour in the bath at home with her 8th and everything in between, but all had been relatively straightforward and uncomplicated, with good outcomes.

    Of course her 9th was the one that started with PPROM and ended up as an emergency CS after placental abruption, finishing up as a massive PPH due to uterine atony.

    In obstetrics past performance as a predictor of current chance of success goes only so far…

  • Montserrat Blanco

    I am so sorry for this family’s loss.

  • Allie P

    I am so sorry for this family’s loss. I am more terrified about AFE than nearly any other pregnancy complication. It can happen at any time and even in hospitals it is often fatal.

    • In my career I have been involved in three — actually more than was statistically probable, given the number of births I attended. All were fatal. It is completely unpredictable, and extremely traumatic for all concerned.

      • Allie P

        How terrible.

  • The Bofa on the Sofa

    OK, so reading about all these people who have 4, 5, 6 homebirths, and wondering about the increase in homebirths that get touted all the time. It seems to me that the number of women actually choosing homebirths aren’t increasing as much as the number of homebirths.

    If this is true, what it means is that the average number of homebirths per woman who do homebirths is higher than the average number of births for women who don’t. I don’t know if it’s true or not, but just throwing the idea out there.

    • fiftyfifty1

      Yes, homebirthing is a thing among the Quiverfull and other similar lifestyles. But I think that explains only some of the increase.

      • The Bofa on the Sofa

        Sure, some of it, but some of it means a lot, I think. For example, if the overall increase is 50%, but the number of women who do HB only increases 25%, that is an important difference.

        • fiftyfifty1

          Yes, it’s an interesting difference. But I’m not sure it’s important in practical terms. We clearly can’t just say “The increase is almost all coming from the Quiverfull, so let’s get the word out there, we don’t need to worry about the rest”. Because it’s the big family religious types but also well off Park Slope hipsters, and Lesbian hippies in Portland, and jeez, the list goes on…

        • bomb

          It’s the same metric behind increased c section. A lot of it is increased 2nd, 3rd, 4th sections.

    • Trixie

      Yes, there seems to be a correlation with religious fundamentalism of some kind.

  • staceyjw

    Its gotten so bad that Dr A reports on dead moms, because death of babies is too numerous to even keep track. And the number of dead moms is rising too, which should not happen in the western world.

    I cannot even imagine this situatiin, how horrific.

  • Mel

    *Shudders*

    “As the pain got worse she looked at me and said it was so hard. I tried to comfort her as best I could. Then she passed out in the tub. I yelled at the midwife and she asked if she had ever done that before and I told her never. We called 911 and got her out of the tub onto the bed. We could see that she wasn’t breathing so we tried CPR. She kind of came to a little bit and was trying to push the baby out with all she had while not being able to breath. She then passed out again never to awaken.”
    What a heart-breaking and horrifying situation.
    1) How did a basic medical history question – ie “Do you have a history of seizures or unexplained fainting episodes?” – get ignored by the midwife until her patient was unconscious in a birthing tub?
    2) How many people did it take to move the mother out of the tub and into a bed? Because I’m a fairly strong woman, but I don’t think even a heap of adrenaline would let me safely move another wet, unconscious, pregnant woman without several other people?
    3) How does that number of people present compare to most home-births where you have the father (maybe) and 1-2 midwives if lucky?
    4) I feel equally horrible for the mother who valiantly tried to deliver her daughter while gasping for breath, her husband who watched his wife, the mother of his children, die while he could do nothing to help her, and a baby girl who never got to live.

    • Ash

      He said they did a c-section in the ED. That would only possibly be done postmortem.

      • fiftyfifty1

        No, mother lived after for a few days.

        We were taught that there are 2 reasons to do a CS in the ER:

        1. postmortem (to try to save the baby)
        2. mother so badly compromised that she is going to need an extensive resuscitation. The goal here is not to save the baby so much as it is to save the mother. The gravid belly and placenta are such a huge oxygen drain and can be such an impediment to proper technique, that a last-ditch attempt to save the mom actually often works better with a gaping hole in her abdomen.

        • attitude devant

          You are, of course correct. That’s why the correct term for this type of c/s is ‘perimortem.’ Because sometimes the c/s assists in mom’s recovery.

          • fiftyfifty1

            I remember the first time I learned about perimortem CS, and how it is done to help mom, not baby (if baby happens to be alive, all the better, but that’s not the point). It drove home for me what an altered and risky state pregnancy is. In what other circumstance would a person’s chances of surviving be greatly increased by slashing open their abdomen before trying to resuscitate them?

        • Cobalt

          “The gravid belly and placenta are such a huge oxygen drain and can be such an impediment to proper technique, that a last-ditch attempt to save the mom actually often works better with a gaping hole in her abdomen.”

          Now THAT’S an “edge state”. They’re not nearly so alluring when they’re real.

          Thank goodness, thank God, thank whoever for doctors and modern medicine.

    • Therese

      I don’t find #1 troubling. Was the midwife supposed to pull out the patient’s chart in that moment and look it over to see if the patient had a history of seizures or fainting? Even if the midwife had asked this question 9 months earlier and remembered that the patient had said no history, it still doesn’t seem like an unreasonable question to ask because I’m sure it happens a patient will fail to to self report something.

      • Mel

        My line of thought was that a history of seizures and unexplained fainting would be a good reason to risk out the mom for a home-birth and would make me cautious about a pool.

        • Montserrat Blanco

          You are right but even in that case, knowing the patient history, remembering everything, etc I would have asked. Sometimes people lie in order to get what they want. It is highly unlikely that a father would lie in that situation though, so I would probably check again just in case.

          • Mel

            Logically, I get what you are saying and I’d probably ask, too. I expect my GP and OB/GYN would need to look at my records – they handle a lot of patients and a history of seizures probably isn’t uncommon in their practice.

            But it scares me because midwives keep swearing that they provide the best-est, most personalized service that is so much better than what an OB can provide.

            So, in that case, yes, I do literally expect the midwife to have memorized the case file. Isn’t that what those 1-2 hour long prenatal meetings are for? Since midwives pride themselves on “personalized” care, she sure as hell better know every damn thing about her clients.

            When I taught, I had roughly 100 students per day moving through our small high school. We usually had about 5 with potentially serious medical problems – unstable type 1 diabetes, epilepsy and anaphylactic shock level allergies were the most common. I knew where the medical kits for each (teenaged) student was, what the signs of each potential problem were and how to initiate emergency first aid until the nurse or paramedics got there. That was part of the job that I volunteered for as a member of the MERT team for my school. I got some paid training through the Red Cross, but did a lot of unpaid hours working with our school nurse to be sure that we had everything ready in case of an emergency. Honestly, for me, I took my responsibility to my students very seriously and took pride in being as up-to-date and prepared for emergencies as possible.

            I still wake up in a sweat remembering a time that a student with diabetes looked pale, sweaty, and confused. She had a blood sugar of 35. I remember trying to keep my voice from shaking as I called the nurse on one line while the secretary called 911 on the other while we got the (amazingly still conscious) student to eat some glucose tabs. I remember a voice in my head saying over and over “Please, God, keep her conscious. Please.

            That student – and all of our other emergencies – survived. We followed the steps that had been so carefully laid out, planned and practiced.

            So what make me ANGRY about this situation is that the level of care that this woman received from a paid psuedo-medical professional is substantially more shitty than what we provided in a poor, urban, underfunded public school in emergency situations.
            That woman died. Her baby died. Her husband lost his wife and youngest daughter and 6 children lost their mom and sister.

            Yes, if you want to deliver a baby at home, I expect you to be super-human – because humans can’t do it safely.
            *gets off soapbox*

        • Bombshellrisa

          It would theoretically be a good reason to rule out laboring in a tub and a water birth too. Midwives don’t always knit in the corner, many also take naps and there isn’t always someone in the room with the laboring woman.

      • TsuDhoNimh

        “Was the midwife supposed to pull out the patient’s chart in that moment
        and look it over to see if the patient had a history of seizures or
        fainting?”

        She should have asked at the first consult … a complete medical history. And she should have re-read her whole set of notes when she arrived at the house to remind herself what had gone on since then.

    • Montserrat Blanco

      1) i would probably have asked again to confirm in that situation.
      2) i would have been able to do it alone and I am a normal woman. You are stronger of what you think and she probably knows how to move patients effectively
      3) that is a serious problem of homebirth.
      4) me too.

      To add: CPR needs to be done on the floor, never on the bed. It is just not effective.

  • Laura

    (I’m the other Laura 🙂 – not the one above) You would think from so many successful prior home births that this birth would be very successful, too. I could understand their false sense of security, but how cruel reality was. I have known quite a few grand multips, myself included, who had a very different and dangerous situation come about after quite a few predictable births. It seems with every birth you raise the likelihood of some unexpected and serious complication arising.

    • Mel

      With our cows, we assume the first birth and the fourth or higher birth needs to be monitored carefully. First births have a higher rate of calf suffocation due to failure of soft tissue to stretch fast enough – but the dam is almost always fine.
      Fourth and up have a higher rate of uterine dysfunction (which can slow birth and potentially smother the calf) and metabolic disorders in the dam post-partum like fatty liver/ketosis, left or right displaced abomasum or milk fever (which is actually misnamed – it’s low blood calcium).

      Either way, we watch the first-calf heifers and “mature” cows like hawks.

      • Laura

        I think very similar parallels exist with humans, too.

        • Dr Kitty

          Yes…
          MLU here don’t take grand multips.
          Baby 5 or higher gets you consultant led care.

      • Medwife

        Same policy in OB 🙂 I have delivered some 9th babies- some families get big around here- and the nurses and I are on pins and needles throughout. That uterus can be tired.

        • Mel

          I had an aunt who managed to deliver 9 kids with only two bouts of gestational diabetes and no other side effects.

          Which boggles my mind, actually.

          • LibrarianSarah

            Did your aunt live in a shoe by any chance?

            Sorry, I just couldn’t help myself.

          • Laura

            Maybe she lived in a library…:) LOL!

          • Laura

            I suspect good genes helped her out!

          • Trixie

            My great grandmother had 15, 13 survived to adulthood. On a farm during the great depression. She happily bottle fed the last few once it became an option.

  • Laura

    There was also a women that died during childbirth in Jan 2014 she didn’t have medical insurance and attempted an unassisted homebirth it stated most of her family didn’t even know she was pregnant she left behind five kids.

  • Cartman36

    I don’t mean to sound heartless but from reading the story it seems like the midwife didn’t even know that you don’t perform CPR on a bed. All you are doing is pushing the mattress in and not compressing the chest enough. This is a VERY sad situation and my heart does go out to the family.

    • Ash

      Unfortunately other cases of improper CPR technique even at the most basic level has certainly been documented at homebirth in the USA (youtube, photos, etc).

      Resuscitation on beds…in someone’s arms rather than on a flat surface, etc. People without gloves. Inflation of the stomach rather than the lungs. Using cayenne pepper solution on a baby’s body.

      • TsuDhoNimh

        “Resuscitation …in someone’s arms”!!!!

        WTF! Don’t they have to be pro-level CPR certified?

        • Ash

          In the USA? No, not necessarily. Some states may require that attendants must have adult CPR and neonatal CPR training, but that certainly isn’t true in every state

    • TsuDhoNimh

      ” seems like the midwife didn’t even know that you don’t perform CPR on a bed”

      I missed that … but you are right.

  • prudentplanner

    I actually noticed the lack of these stories from SOB in 2014, I naively thought it was because the deaths had stopped (or slowed). The year end summary from Amy was a bit of a shock to me.

    I am so sad for all these families.

  • The Computer Ate My Nym

    This is probably a dumb question, but in the ideal world where home birth midwives risked out those who are high risk and people sensibly didn’t try unassisted birth, wouldn’t a grand multi be a poor candidate for home birth? Several of the women who died were having their Nth baby and should have at least been advised to think twice about home birth (even by a home birth midwife who would consider a low risk birth at home perfectly reasonable)?

    • The Computer Ate My Nym

      Looking again at the CDC wonder data, using a fairly loose definition of “eligible for home birth” (37+ weeks, 2000+ grams, age birth to 27 days, pretty much no other restrictions), I get data that suggests that while the first birth is the most dangerous, the risk starts to rise after the second and rises pretty rapidly after the 3rd such that the risk for the 6th+ birth is almost as high as for the first (2.33/1000 versus 1.89/1000).

      • The Computer Ate My Nym

        Also to note that this is an undercount. For example, this child was probably not included since she died in the hospital. An intent to treat analysis would look just awful.

    • In the UK in the 70s, neither primips or women having their fifth or subsequent births could have home births. In hospital the midwife and an OB jointly managed the case.

      • fiftyfifty1

        That seems like a very sensible guideline. Too bad it changed to what it is now.

        When the Birthplace study came out and showed clear increased mortality for primips at home, I was thinking that this would be widely publicized and that the official recommendations would change. Instead it’s hidden away on the website and couched in terms of “might want to consider…” Ideology over lives.

        • Roadstergal

          I had another one of those painful conversations with my UK NCB friend today, one of those that just drains me. She is convinced that the Birthplace study showed that homebirth is just plain always safer – because that’s everything that she’s read and heard about it. It’s most of what’s driving her planned HBAC, I’m sure.

  • ArmyChick

    I know someone who is friends with this family. She has had 5 homebirths herself. (One unassisted). She was shocked when this happened…but is already talking about looking forward to having another homebirth.

    It boggles the mind.

    • Isilzha

      I can’t wrap my mind around the cognitive dissonance for that. :/

    • Amy M

      I glanced at the fb thread that Dr. Amy linked—even the father of these now motherless children is advocating for hospital birth. Someone asked him point-blank, if he was suggesting hospital birth, and he said had they known about AFE, they would have wanted a homebirth-LIKE birth (so unmedicated I guess), in a hospital, or at least next door to one. It’s unfortunate he had to learn the hard way, but he does recognize that proximity to emergency services can make all the difference. I hope your friend can learn from this, and not have to have her own disaster.

      ETA: I see someone else already mentioned this below. My bad, for not reading all the way through before responding.

      • KBCme

        Proximity still doesn’t cut it, IMO. Even if the birthcenter or home is across the street, how many minutes (looong, looong minutes of bleeding or no pulse, or difficulty breathing) does it take to either get the mother in a car and drive to the ER, get her out and start treatment, or call an ambulance, wait for the ambulance to load mother, drive her the block away, unload her?…. I mean, when you are bleeding out or not breathing, even 5 minutes can mean the difference between life or death.

        • Amy M

          Oh, I’m with you…across the street wouldn’t be close enough for me either. Probably not close enough to save this woman with the AFE either. It may be close enough to deal with many complications that might arise, but as people here say “Time is brain” and I’d rather the OR be right down the hall.

          Hell, I had a PPH in the hospital and avoided a transfusion because a nurse was standing in front of me at the time. If it had taken a few more minutes for help to arrive, I’d likely have received that transfusion. And if I’d been at home waiting for an ambulance? I’d be dead.

          However, for a guy from a homebirthing family to even admit that being near resources makes a difference—that’s a big step. More often we hear denial: things like “She would have died in hospital anyway. There was nothing anyone could have done. The hospital would only have made it worse. Etc.”

          • Cobalt

            “I’d rather the OR be right down the hall”

            And me with an IV already going, already in easy-off hospital clothes, in a bed on wheels, with neonatal specialists racing me there.

        • Daleth

          Some hospitals offer “home birth-like experiences” with CNMs, but the OBs and OR are just down the hall. That may be what he’s talking about.

  • CrownedMedwife

    I am also so sorry for this family’s loss. I hope this husband’s message regarding AFE awareness is heard by HB community as a plea for women to carefully choose location and provider for the safest birth and not disregarded as a rare fatal outcome. HB could never have saved her, but a hospital just may have.

    Having recently come away from a near-miss and a myriad of circumstances of several mothers who would not have come away with their own or their baby’s lives in a HB attempt, reading this man’s story is particularly raw…if that is even a possibility.

    JAMA Feb 2015 has a moving opinion piece on a physician who DID survive an AFE and shares the fundamental value of resources from simple evaluation to intensive intervention.

    • Cobalt

      From a commenter on the father’s FB page:
      “I am so very sorry for your loss. I can not even imagine. At the same time, I am inspired by your faith and trust in God. May I ask… am I understanding you correctly, that you are saying you would have chosen a hospital birth (had you known more about AFE)? And you are wanting to advocate that others choose the same? Or are you more wanting to raise awareness so that a cause and cure for AFE might be found? I am just wanting to make sure I am understanding correctly! Thank you.”

      His response:
      “hind sight is 20/20 but I would have a home-birth type birth but either in or next door to a hospital. The awareness is to find a cure or warning signs or something. Hardly anyone knows about it. But hopefully more know about it now. Miranda Klassen has founded afesupport.org and is helping develop research in order to find answers. We are supporting her as this is a ministry where she must raise support in order to live. ”

      • Jocelyn

        Also in the comments:

        “So sorry for you and your family. Don’t know how you deal with something like that. My wife also had 6 successful homebirths, only to have the seventh fall completely apart. Our daughter died, but thankfully my wife was OK. Will be praying for all of you.”

      • Melissa

        I wonder what “home-birth type birth” means? Is it a situation where the hospital room has soft lighting and uses your birth soundtrack? Is it water birth? Is it just another way of saying “no pain management, no c-section, no interventions”. When I see a term like that I just wonder what is it that they are picturing.

  • fiftyfifty1

    I am so sorry for their loss.