Why do homebirth advocates worry more about the infant gut microbiome and the antibodies in colostrum than brain damage?

Wounded Brain

I have written about it more times than I care to count.

VBA3C homebirth: ruptured uterus, brain damaged babVBA3C homebirth: ruptured uterus, brain damaged baby
You risked your baby’s brain function for this?
Another homebirth, another brain injured baby, but the midwife was awesome
Unassisted birth: surprise second twin suffers brain damage
Conflicted: successful VBAC, brain damaged baby
He’s a spastic quadriplegic as a result, but she’s glad she had a homebirth
Another unassisted birth, another brain damaged baby

Lest you think that brain damage at homebirth is merely an anecdotal experience, consider that investigators have found that homebirth increases the risk of hypoxic brain injury by more than 1700%.

I read about another such “beautiful birth” just yesterday:

No one can possibly care more about the microbiome or breastmilk than about brain damage, can they?

The midwife quickly realised Poppy hadn’t turned herself and was shoulder dystocia …

They had to do an episiotomy (with no pain relief..!) Luckily it worked and nearly 4 minutes after her head was born the rest of her came out. She was blue, floppy and unresponsive but had a strong heart rate…

Poppy suffered birth asphyxiation and HIE (Hypoxic ischemic encephalopathy) she was taken to neonatal intensive care where she was placed onto a 72 hour cooling treatment where they wrap a fluid filled mat around the baby and keep them at 34 degrees to give the brain and organs time to repair themselves after being starved of oxygen. She had probes and wires just about everywhere monitoring every aspect of her.

Does Poppy’s mother have any regrets? Of course not. What’s a little brain damage (HIE) compared to a birth experience!

People often ask me if I regret my homebirth because of the circumstances but it has only made me feel like the homebirth was even more right for us. I laboured well at home and was relaxed and in my own environment, I think the panic that would have happened at the hospital would have freaked me out and I’d not have been so productive in pushing. The shoulder dystocia could have happened anywhere and the outcome of treatment would have been the same.

What happened to baby Poppy’s brain when she was deprived of oxygen?

As her brain sensed a decrease in oxygen and an increase in carbon dioxide, she tried to raise her blood pressure to get more blood to her brain. Epinephrine flooded her bloodstream and blood was diverted from inessential organs to the brain, heart and adrenal glands.

A baby can do this for only a limited amount of time and blood pressure begins to fall.

This leads to intracellular energy failure. During the early phases of brain injury, brain temperature drops, and local release of neurotransmitters, such as gamma-aminobutyric acid transaminase (GABA), increase. These changes reduce cerebral oxygen demand, transiently minimizing the impact of asphyxia.

What happens at the level of individual brain cells?

… During cerebral hypoxia-ischemia, the uptake of glutamate the major excitatory neurotransmitter of the mammalian brain is impaired. This results in high synaptic levels of glutamate and EAA receptor overactivation … and kainate receptors… Accumulation of Na+ coupled with the failure of energy dependent enzymes such as Na+/ K+ -ATPase leads to rapid cytotoxic edema and necrotic cell death…

EAAs accumulation also contributes to increasing the pace and extent of programmed cell death through secondary Ca++ intake into the nucleus. The pattern of injury seen after hypoxia-ischemia demonstrate regional susceptibility that can be largely explained by the excitatory circuity at this age (putamen, thalamus, perirolandic cerebral cortex). Finally, developing oligodendroglia is uniquely susceptible to hypoxia-ischemia, specifically excitotoxicity and free radical damage. This white matter injury may be the basis for the disruption of long-term learning and memory faculties in infants with hypoxic-ischemic encephalopathy.

The damage doesn’t end when oxygen levels are restored to normal.

During the reperfusion period, free radical production increases due to activation of enzymes such as cyclooxygenase, xanthine oxidase, and lipoxygenase. Free radicals can lead to lipid peroxidation as well as DNA and protein damage and can trigger apoptosis. Finally, free radicals can combine with nitric oxide (NO) to form peroxynitrite a highly toxic oxidant.

…[A] second wave of NO overproduction that can be prolonged for up to 4-7 days after the insult.

This excessive NO production plays an important role in the pathophysiology of perinatal hypoxic-ischemic brain injury. NO neurotoxicity depends in large part on rapid reaction with superoxide to form peroxynitrite.[11] This, in turn, leads to peroxynitrite-induced neurotoxicity, including lipid peroxidation, protein nitration and oxidation, mitochondrial damage and remodeling, depletion of antioxidant reserve, and DNA damage.

In other words, even a limited period of oxygen deprivation can lead to a cascade of cell death and further brain damage from the extremely toxic products of cell destruction.

What does that mean for the baby?

In severe HIE it can mean:

  • Stupor or coma is typical; the infant may not respond to any physical stimulus except the most noxious.
  • Breathing may be irregular, and the infant often requires ventilatory support
  • Generalized hypotonia and depressed deep tendon reflexes are common
  • Neonatal reflexes (eg, sucking, swallowing, grasping, Moro) are absent
  • Disturbances of ocular motion, such as a skewed deviation of the eyes, nystagmus, bobbing, and loss of “doll’s eye” (ie, conjugate) movements may be revealed by cranial nerve examination
  • Pupils may be dilated, fixed, or poorly reactive to light
  • Irregularities of heart rate and blood pressure are common during the period of reperfusion injury, as is death from cardiorespiratory failure

Less severe HIE has less severe consequences, but no one should think that a baby who appears to recover has emerged unscathed.

What does infant cooling therapy do? By lowering the metabolism of brain cells it appears to limit cell death and the release of the toxic products of cell death. It can’t reverse brain damage that has already occurred, but it can limit the continuing damage that inevitably occurs when oxygen levels return to normal.

That’s what happened to baby Poppy, yet her mother seems to think that this is a trivial outcome.

Here’s what I want to know, and perhaps homebirth advocates can explain it to me:

You’re the folks who worry about C-section changing the infant gut microbiome and you are horrified if a baby deprived of the antibodies in colostrum because her mother does not want to breastfeed. Why do you think that is important but oxygen deprivation and brain damage are no big deal?

This raises the ugly possibility that homebirth isn’t about babies and what’s beneficial for them, but about mothers and their bragging right and midwives and their autonomy.

No one can possibly care more about the infant gut microbiome or breastmilk antibodies than about infant brain damage, can they?

  • yentavegan

    in a hospital with a fully trained staff..how is shoulder dystocia handled to assure infant does not suffer from lack of oxygen?

    • Sara Barnson

      There are several maneuvers that can help if they are used quickly enough. I’m not an expert (yet), but from what I know these maneuvers can usually dislodge the shoulder with minimal damage if the staff are well-trained and recognize shoulder dystocia quickly to act. Other interventions include breaking the baby’s clavicle to get them out as soon as possible. Why? Shoulder dystocia is a nightmare – that’s why so many pregnancies that are at high risk of shoulder dystocia end in c-section.

  • guest

    And that is why when my daughter was having abnormal heart decels I didn’t give a shit whether there was a good chance that all was well and I could birth her vaginally and we’d all be fine. There was a clear signal that maybe something was wrong and she wasn’t going to tolerate it unscathed. Cesarean for us, thanks. It wasn’t an “unnecesarean,” but a better-safe-than-sorry-sarean.

  • Anna

    I laboured well at home and was relaxed and in my own environment, I think the panic that would have happened at the hospital would have freaked me out and I’d not have been so productive in pushing. The shoulder dystocia could have happened anywhere and the outcome of treatment would have been the same.

    Stupid ignorant cow! At the hospital they would have given you a c-section which would prevent brain damage and shoulder dystocia. HIE and shoulder dystocia – what a nuisance compared to a nice birth experience! WHY do such people get pregnant? They don’t need babies, they don’t care the smallest bit for the babies. Why don’t they just shove a melon up their vagina and enjoy the pushing?

    • Anonymous

      They need props for their sad little pieces of performance art.

    • Mac Sherbert

      When I read that I thought “I can’t do stupid today”.

  • Gatita

    OT but interesting: Study finds standard for measuring fetal growth flawed for non-whites

    Latino, African-American and Asian babies tend to weigh less at birth than white infants but that doesn’t necessarily mean they are too small even though they might be classified that way, according to a new study from the National Institutes of Health.

    • araikwao

      Yes, it’s well-established that population norms do a lousy job at detecting IUGR, so Gardosi and colleagues developed the customised antenatal growth chart, which takes into account the mother’s height and weight, and to a smaller degree, ethnicity and other factors. Has been shown to reduce the incidence of stillbirth and improve IUGR detection whilst not over-investigating the constitutionality small babies.

  • Fallow

    I had a shoulder dystocia when our baby was born. My child did not develop any hypoxic brain injury at all. She does not have HIE. She had to be treated for physical injuries resulting from the dystocia (and the results have been great), but her brain is fine. The outcome was so, so much better than what happened to poor Poppy.

    I attribute my child’s lack of HIE, to the obstetrics team (doctors and nurses) who knew exactly what to do during a shoulder dystocia. There was a NICU team already waiting for my baby, too. While I long for the day in which children don’t get physical injuries from shoulder dystocia, I am so, so grateful they saved her brain and her life.

    • Montserrat Blanco

      I am really happy that your child is doing well and very sorry that you had such a frightening experience.

      • Fallow

        Thank you so much. As far as anyone can tell, she’s completely fine now. I think my point is that even though our outcome wasn’t great, it was a lot better than HIE.

        I had a physical issue that contributed to our daughter’s injury. Plus she was LGA, and I am small. If I knew then what I know now, I’d have requested a c-section. There were valid reasons that my doctors did not want to perform a c-section on me, but I still would have preferred it for my child’s sake.

        I’ve learned from this experience that many NCB people expect obstetricians to perform flawlessly every time. If a midwife had delivered my baby with a similar injury, or with HIE, they would expect me to forgive her. Because everyone makes mistakes, some babies aren’t meant to have higher brain functioning, whatever. Obstetricians aren’t permitted this leniency by the NCB crowd. You are entitled to forgiveness for destroying a baby’s life, if your favorite words are “natural”, “herbs”, “doula”, “birthing pool”, “variation of normal”, and so forth.

        That’s not to say that I believe bad doctors should get away with it! It’s just interesting that their loyalties are so idealogical. These NCB folks deeply want me to treat our experience as evidence that obstetricians are worse than midwives. And it’s just not true.

        I am not God, and I can’t say if my child’s injury was preventable or not. I do know that it could have been much worse if I’d let some uneducated lunatic deliver my child away from all the benefits of modern medicine.

  • I really think that, for most laypersons, the implications of HIE are really not understood. Some do understand intellectually, but deny that it’s really going to be dire — after all, babies don’t do anything much initially anyway and “maybe the baby will outgrow it”. Friends and family will regale them with “similar” stories which all had good endings. And of course, doctors cannot initially predict the extent of brain damage. They are hardly going to announce “here’s your child, the vegetable, because of your stupidity”

    • nomofear

      Right. You’ll read so many hb blogs “the doc said it could have happened here too” – dummy, you’re so brainwashed by the NCB crowd, you don’t understand that medical staff are, by and large, kind, caring people who actually follow the Hippocratic oath. They look at you, misguided mother to a damaged or dead child, and they know that telling you the whole, unguarded truth would either trigger a major, major case of PPD, or it will backfire entirely, since they know that hb/NCB folks don’t trust the medical industry to begin with. So they tell the lightest form of the truth. Yes, it could have happened here at the hospital, too. What they leave off is the rest of the truth, that, most likely, their baby would have been okay, because that would either cause the parents the worst kind of despair, or cause them to double down and reject all future medical treatment. Either outcome fights first, do no harm, in a twisted way.

      I say this as a lucky mother to a five year old who I birthed in a freestanding birth center. Only when pregnant with my second did I find this site and come to understand that we were incredibly lucky to come out of that unscathed. I was fully brainwashed by the NCB industry. And so, so lucky.

      • Amazed

        I remember one of your first posts here. It ended up with something like, “Hospital and modern medicine, here I come!” I remember grinning from ear to ear, as I did when I read about your second time in the trenches. Lucky and knowing it. A perfect combination.

        ETA: There was this OB who explained her side of the “It would have happened at hospital too!” I think it’s worth a read.

        http://www.10centimeters.com/natural-birth/guest-post-what-we-say-to-loss-moms/

        • Amy M

          And then there are the NCBers who insist that when other women say “I would have died at home” or “My baby wouldn’t have survived a homebirth” they swear up and down that they can’t actually KNOW that, and that being at home would have prevented complications. Nice double standard there.

          • demodocus

            I can’t actually *know* that if I eat moldy bread I’d get sick, since I’ve never tried it, either.

          • Azuran

            I tried it once (accidentally of course, didn’t check both side of the bread before making a sandwich)
            I didn’t get sick. Which proves without a doubt that eating moldy bread is not dangerous in any way.
            If you get sick from moldy bread, it’s only because you were probably born by c-section, in a hospital, where they put a hat on your head and didn’t give you instant skin contact with your mom. Also, I bet you were formula fed and vaccinated.

          • Daleth

            And you didn’t “trust bread.”

          • demodocus

            Not with my hippie mother, lol. I was born in a hospital and vaccinated, though.

        • sapphiremind

          Also, working in the NICU, I’ve been directly asked. You can’t tell a grieving mother “yes, this is all your fault, it could have been prevented” any more than you can say “The community hospital you birthed at screwed the pooch and your kid is dead because of that”. You can’t assign blame and you can’t point fingers. ESPECIALLY not at the grieving family.

      • Anonymous

        True. the same line “it can happen anywhere” line we get at my hospital as well. The difference comes down to how we handle it. We see shoulder dystocia in our OB ward too, but skilled OBs and their nurses know how to handle it.

    • Mac Sherbert

      I know I’ve said this before, but as special education teacher HIE was a major concern for me. It’s why when they discovered my baby was breech I said C-section before my doctor did. Maybe it’s because I worked in a special needs school or maybe it’s because of the parents I saw in tears trying to deal with their kids with developmental delays or learning disabilities, but brain function is way at the top of my list of things to preserve.

  • KarenJJ

    What’s with this idea that hospital staff panic or create panic? It’s like they’ve only seen hospitals on TV with all the drama added in. I’ve had one scary episode and it only registered as scary after the event. I took Miss 3yo to emergency at the children’s hospital because of headache, vomiting, fever and falling asleep in the middle of the floor and being difficult to get her to wake up…

    I popped her into the car and took her to the hospital (she has a rare disease and the hospital knows more about what to do when she’s ill enough to see a doctor quickly). The triage nurse heard this, took one quick look at her and to my surprise we weren’t sent onto the waiting room but were given a bed immediately and a doctor was there within seconds and tapping her knees with a little hammer.

    I figured out afterwards what they were all so concerned about. That was when I felt panicky and wondered why the heck I didn’t ring for an ambulance when she fell asleep and was difficult to wake up to start with. Anyway, turned out to be a nasty respiratory infection and no meningitis. The staff were cool and calm and doing their jobs. Nobody was running around shouting or creating panic.

    • Amy

      I have to jump in to second this. I’ve always had piss-poor platelet counts every time they’ve bothered to check. Doesn’t matter how many leafy greens I eat, either. That became a problem with my second c-section when I lost so much blood I almost needed a transfusion.

      We found this out not only after the fact, but well after the fact. At the time, I attributed my lethargy and general lack of awareness to the drugs (when it was a spinal, hello!) and the fact that I’d been in labor around 31 hours, awake the whole time, before the surgery. My husband, who wasn’t allowed in the OR because he was sick, was waiting just outside the recovery room and kept seeing women being wheeled in and then wheeled out while I was still in there. He finally asked and they told him.

      The reason we had no idea? Because everyone was so calm and just did their jobs the way they were supposed to.

      • KarenJJ

        I read an interesting book by Amanda Ripley about disasters. One of the issues is that people don’t behave in disasters as they expect they’ll do. The ability to think rationally and logically can disappear. Odd behaviour – like collecting their gear together- becomes a focus and an automated thing – instead of evacuating (eg evacuating an airplane people still try to take their carry-on despite knowing better). One of the big issues is that people often don’t panic and move when they should – denial is a very powerful driver of behaviour in disasters.

        The best way to prepare for disasters is experience – so practise and drills become very important. Hospitals, military and emergency services are very aware of this and practise worst case scenarios. The problem is when disasters happen they’re not the first on the ground – ordinary people are. In the case of midwives – how many do drills where they recognise an issue quickly and move things along efficiently and appropriately? Or do you just have a few interested bystanders without the experience and knowledge to act in the way to get the best outcomes for mum and baby?

        • When my mother was 62, she had an episode of chest pain and wound up in the ER. At the time, I was on sabbatical from nursing school, and, living at home, worked as an admissions clerk in a different hospital. Dad notified me, and, after fretting myself into a near frenzy, ran over to the ER where Mother was at the end of my shift [couldn’t leave before as I worked alone].

          As I entered the ER, I relaxed: this was normality! I spied a little old lady, sitting bolt upright on a stretcher and screaming at everyone “Get me out of this hole!”

          For the first time in my life, in my very difficult relationship with my mother, I thought, “she’s terrified, that’s why she’s doing this. Attack before you are attacked”. Instead of yelling back at her, I found that she was now The Patient, and I could deal perfectly well with her. At this point a man in white with a gigantic name tag with “Chief Medical Resident” on it approached her. “Mrs. X, I’d like to ask you a question..”

          “You get away from me”, yelled my mother, ostensibly in the throes of an MI, “I have a daughter who’s a nurse and I know all about you interns!”

          I just smiled.
          [In the event, it wasn’t — then — an MI, and we became quite good friends afterwards]

          It’s a discipline that gets into your bones. In a crisis, you CAN’T panic; once the patient or situation is stable, then you can go into a corner and go to pieces. But not during an emergency.

          • Gene

            I’ve sometimes had family members get upset when all hell in breaking loose and the ED staff is calm. I tell them that one of my jobs is to stay calm and if I am panicking, I am not doing my job. Calm in public, cry/freak in private (or during the staff meetings after)

          • Dr Kitty

            I have found that saying “do I look worried? You only need to worry when I look worried” is a good way of calming patients.
            I have a good poker face.

            Honestly, keeping up the patter and being calm and looking chilled out while inside you’re freaking out is part of the skill.

            If you’re my patient, worry if I go quiet. It means I don’t have the energy to keep up the schtick and deal with the problem.

          • Kelly

            With this last delivery it took a good long time for my placenta to come. I pushed more with the placenta than with the baby. I know from this site that it was not a good thing at all but my OB was so calm and serene that I did not panic. Thankfully, it finally came out complete and I did not bleed out. My nurse commented much later that she was worried that I would have to be rushed to surgery. I am so thankful for the calm way in which she handled it even though I am sure she was quite worried about it.

          • I’ve found that my being diabetic is the best way to teach GDM mothers who claim they are too needlephobic to ever be able to test their blood sugar. I pull out my glucometer and say ” Now I’m going to test my blood sugar. I want you to watch my face as closely as you can. That will show you, more than anything I can say, whether it hurts to prick my finger or not”

        • Amy M

          Yep. When I had a pph at the hospital, a nurse who was in the room yelled for help, but after that there was no yelling. The doctors and nurses seemed calm, at least in my memory. I, on the other hand, was fighting to stay conscious and then I was insistent on getting to the toilet because I was horrified by the mess I was making. I don’t know if my reaction was more from being in an emergency situation, or more confusion from blood loss, but its a good thing there were professionals there right awy.

        • MaineJen

          It has been said that one of the reasons there weren’t more fatalities from the Boston Marathon bombing was because there were already so many medical personnel on hand to assist the runners. When the emergency happened, these people were able to follow their training and respond quickly to those who needed help. Having many world-class hospitals within easy distance helped, as well.

          Also, flight attendants are trained to YELL at passengers as loud as they can when evacuating a plane after a crash. It is supposed to snap people out of their denial/stupor and get them moving faster.

        • sapphiremind

          There’s a very special tone of voice that gets used for emergencies like dystocia. “Can someone please see if we can get a hand?” in what appears to be a very calm voice is actually overly calm and it is code to everyone else in the room that shit is going down, we need help, ASAP. In NICU codes, there’s a lot of activity, but not panicking. Panic is bad. Panic means you don’t know what to do. Panic is worthless to help. You stay calm, do what you know how to do and hope for the best.

    • Jen

      Yes! My husband is an anaesthetic and recovery nurse and whenever he responds to an emergency he takes his time to see exactly what’s going on and follows procedure calmly and rationally. It goes without saying that he was a fabulous support during my three labours.

    • Fallow

      Exactly. During my dystocia, I had no idea there was anything wrong. In part because I was so sick that I couldn’t tell up from down, but in part because the doctors and nurses didn’t panic like a bunch of children. They seemed a bit worried, but professional and calming.

    • Angharad

      Yes! When I was pushing with my daughter her heart rate dropped into the 80s. The nurse paged my OB, who was there within two minutes and my daughter was delivered within two more minutes. It happened quickly but there was no shouting or panicking, just calmly dealing with the situation at hand. The doctor did tell me it was very important that we get the baby out right away when we asked for consent to use an episiotomy and forceps, but she had a soothing tone of voice and a plan to deal with the problem, so it still didn’t create panic.

    • autumn

      I don’t get it either. I’ve ended up in the emergency room several times and I was in hysterics because I was hurting so badly and scared to death. The nurses always were able to calm me down, and that was before they gave me the good painkillers in the IV.

    • Jessica

      A few months ago my husband had surgery to drain a perianal abscess. Shortly after the surgery his doctor called and said I would be able to take him home that night; a few minutes later I was told he was being admitted because the post-anesthesia unit was concerned about his heart rate. It was many hours later that I learned my husband actually had sepsis and the post-anesthesia unit was busy flooding him with IV antibiotics and trying to stabilize his blood pressure, temperature, and heart rate before deciding whether to send him to the step-down unit or another unit in the hospital. The situation was beyond frightening for both of us, but the physicians and nurses we met with at every step of the way were very calm and collected, and did their very best not to alarm either of us. It was impressive.

      • The Bofa on the Sofa

        I remember an old comedy routine (can’t find it) that was talking about how pilots are always calm. They come on the intercom with things like,

        “Well folks, we’re getting a silly little indicator light up here that’s signalling some problems with the landing gear, so we are going to fly near the tower for the guys down there to check out what they can see. If you look out the window, we might get a little close to the tower, but that’s just to check things out.”

        next

        “Well folks, the guys in the tower have advised us to head out over the ocean before we land so we can dump out some excess fuel, just to be on the safe side when we land. We’ll just take care of that first and we’ll be on the ground shortly.”

  • Hilary

    Oh, Dr. Amy, emotionally manipulating mothers with your disgustingly scientific descriptions of brain damage … Don’t you know there’s nothing one can possibly do to minimize the risk of HIE? Certainly not proximity to unnecessary interventions like fetal monitoring and c-sections!

    My OB was just like you, pretending to care about whether my baby suffered brain damage. He claimed I needed a c-section due to risk of shoulder dystocia – but now I know from stuff I’ve read on the internet that it was unnecessary and he only said that because he wanted more money (although he also ordered me to deliver at a hospital where he didn’t work, so I’m pretty sure there was no way he got paid for that section … still, I’m sure it benefited him somehow). If only I had done more visualizations while pregnant, I’m sure I could have delivered vaginally at home, and then my son would have normal gut flora.

    • Isa

      Oh Hilary, emotionally argumenting to support your own choices and beliefs based on, ahem, “stuff you read on the internet” ? (Applause)
      Dr. Amy’s mission is to give women proper data and information about birth, period.
      Scientific descriptions are not “disgusting”, they are precise and proper.
      You are right, hie cannot be prevented, but speed of intervention on that poor baby could make the outcome of her birth, and her life so much better.
      We go crazy about not feeding kids organic food, wearing a snowsuit in their car seat, being put, oh the horror, in their bed rather than co sleeping, and judge those that do note make the same choice but treat severe brain damage like a minute detail in an otherwise perfect birth.
      I am sorry, but the world of mommy war has gone crazy, and it makes me sad. So much selfishness…

      • Inmara

        I think that her post actually was intended to be parody of woo infected NCBers. But it’s rather frightening that such gross and absurd statements can be written by real people who in all seriousness believe in them.

    • Charybdis

      All the visualizations in world cannot change the facts, no matter how much you want them to. And yes, there is PLENTY of things one can do to minimize the risk of HIE, The involve things that apparently a whole lot of people that are ass-deep in the woo refuse to acknowledge as beneficial. Things like monitoring the baby’s heartbeat (the HORROR!!!), getting an IV line or hep lock into the mom so that medications can be administered in a hurry if necessary, vaginal checks to monitor dilation, stuff like that. All of which are necessary if you want to MINIMIZE risk of HIE. You cannot get a guarantee that your baby will not have HIE, either in the hospital or at home. Your chances and your baby’s chances are better in a hospital, because the people there deal with mothers, babies and deliveries every damn day. It may be one of the most important days in your life, but for the medical folks, it is what they do every day, They have seen a whole LOT of things, both good and bad, ,and know how to deal with them calmly and efficiently.

      Just because *you* don’t feel like you need even the bare minimum of monitoring to reduce the risk of an adverse event during your baby’s birth, does NOT mean that those things are then rendered useless. Do bad outcomes happen in the hospital setting? Sure. Noone has said that giving birth in a hospital is a straight up guarantee that nothing bad will happen to the baby But, the professional help (docs, nurses, NICU, OR, equipment, drugs, etc) are already THERE and can be summoned in seconds to minutes. And in things involving oxygenation of the body and brain, SECONDS MATTER.
      I cannot wrap my brain around the tact that so many people have been seduced by the woo. And believe the shit they shovel as “fact” or “variation of normal”. Mother Nature is a heartless bitch and there is a reason so many women in history have died in childbirth or of “childbirth fever”. Or have major complications due to tears and fistulas due to the tears. Breech births are fine to do without medical monitoring, twin births don’t need monitoring, there is no complication that cannot be managed at home by a midwife (CPM). If they can handle *everything* why do so many failed home births wind up being transported to the hospital where the evil, soulless doctors are?

    • Roadstergal

      Isn’t it sad that a Poe looks so much like the real thing? Excellent snark, however. 🙂

      • Hilary

        I think I’ve been talking to too many NCBers/reading too many comments on this website. Glad someone figured it out!

        But, I did really have a c-section to prevent dystocia, thanks to an awesome OB who went out of his way to research my son’s rare condition after seeing us only once.

    • Tigger_the_Wing

      Great satire, spot on.

      It terrifies me that people still actually think this way. It was one thing for my mother to have home births between 1957 (me) and 1970 (my youngest sister); our local hospitals didn’t have the modern equipment they have now, and it took so long to prepare for a Cæsarian that it didn’t matter much if one were in a hospital bed or an ambulance on the way. It was borderline in the eighties when I was having my older kids. Even in hospital, because of shortages of modern equipment and the staff trained to use them, OBs and midwives still used those ear-trumpet things instead of EFM for almost everyone.

      By 1993, though, when I had the twins, epidurals were a well-tested procedure, EFM was plentiful, simple for anyone to use and accurate, U/S scans were amazingly detailed and could be seen in real-time, and staff were accommodating about music, light-levels etc. I was astonished that there were still hold-outs who wanted a home birth. With all the mess? The possibility of traumatising older kids if things went wrong? (I still remember my brother when our youngest sister was born – I swear he paced more than Dad did). I used to get shirty with people suggesting home was better.

      That we are still having to discuss home birth disasters twenty-something years on is outrageous to me.

  • CognitiveDissonaceHurts

    I was recently hospitalized for a gyn. issue. There was a loooong code pink, and my nurse later told me it was a shoulder dyst and the baby would have died at home. 🙁 It gave me the chills because like others, I was never made aware of the danger I put my 4 home birth babies through because “we’re close to the hospital”.

  • JJ

    This is why the blog is so important. I had 3 babies at home and had never heard anything but, “there will be warning signs”, “we can transfer in time” ect. I am so thankful to be giving birth in a great hospital any day now.

  • Mary Hopkins

    I was terrified of homebirth after a friend of mine’s went bad and her child now has cerebral palsy. It’s possibly to have an unmedicated birth in a hospital where professionals can properly handle an emergency. Why would you ever risk the life and health of your baby anywhere else?! Also, I know more homebirth babies than hospital babies. SMH!

  • Liz Leyden

    Poppy’s brain damage may emerge as learning disabilities once she starts school.

    • Amy

      Which they’ll turn around and blame on vaccinations, un-natural foods, too much screen time, and mean lazy teachers who want to throw all the kids into special ed (even though it costs schools a lot more to offer special educational services to students).

    • Poppy’s brain damage may manifest itself long before that. Although there is a lot of variation in developmental milestones, if certain skills are not mastered [sitting up, walking, talking, etc.] by a certain age, there is cause for concern, even if she doesn’t have a seizure disorder or is blind, or something like that.
      Her parents will undoubtedly think that not walking by age two, or talking by age 4 is a “variation of normal”.

  • RainyDayPessimist

    Two possibilities: First, the brain damage won’t be really obvious until long after the midwife has gotten away with her money. Second, for an attachment parent what could be better than a child who is forever dependent on the parents?

    • They become too heavy to carry around, eventually. And feeding a 20 year old, and toileting him/her when you are nearing retirement and have arthritis isn’t fun.

      • Azuran

        But think of all the bragging rights they get from it!

        • Amazed

          Part of the bragging rights is a “very independent, well-adjusted child”. I can’t see it in Antigonos’ scenario.

          By the way, I recently learned that there was another Antigone besides the Sophocles’ one.

  • autumn

    Or how about the brain damage that comes from depriving newborns of nutrition and letting them starve instead of giving them much needed formula? One of my cousin’s children has learning disabilities and the doctors have chalked it up to him not getting enough nutrition his first six months because my cousin refused formula and he was getting enough to survive but not thrive. At his six month ped visit, he was finally low enough that the ped said give him formula or she was going to call CPS. He was a miserable crying baby up to that point and then he was finally happy. I also have to think the stress of crying constantly for six months probably screwed him up too. Yet cousin thinks Ferberizing is child abuse.

    • Inmara

      Poor baby! I was so embarrased when we realized that our baby is fussing and crying so much not only because of colic but also because he didn’t get enough milk. After first bottle of formula he happily fell asleep and we are supplementing ever since.

    • sdsures

      The idea of someone deliberately starving their baby. It’s just inconceivable.

  • LizzieSt

    That people would risk their babies’ brain function so recklessly, so thoughtlessly, makes me so angry I can barely see straight. My husband’s brother suffered brain damage at birth. Granted, East Germany in the 1970s was not exactly famous for its stellar obstetric care. But his mother gave birth in a clinic run by nurses and midwives. She chose to give birth there instead of in a hospital maternity ward because the birth clinic was known for its “warm, individual care” as she put it. The downside was that even the limited obstetrical interventions available in East Germany in the 70s were not available to her. During the birth, the umbilical cord somehow became compressed (might have been wrapped around his neck, it’s hard to gather every detail forty years on) and the baby’s brain was deprived of oxygen. Could this have been prevented in a regular hospital back then? Maybe not. But he now has a moderate mental disability. With the support of government and church agencies, and a loving family, my brother-in-law has been able to build a good life for himself. He has a job in a sheltered workshop, he has an apartment, he plays sports. He can read. He can even speak and understand some English.

    But as I said: The fact that some people are so unconcerned with something that can severely impact a child for the rest of his life…..I just cannot grasp it. Hearing this story from my mother-in-law is what convinced me once and for all that a pleasant “birth experience” means nothing at all if it comes at great risk to a child.

  • RMY

    I really suspect she doesn’t think an ob would have caught out resolved the issue faster. Or maybe she would’ve refused the treatment even in the hospital. Just how she says being at home where she felt her pushes were better than they would’ve been at a hospital makes me think she doesn’t think intervention would’ve happened earlier.

    • mostlyclueless

      I am sure she has been told by her trusted medical professionals that nothing would have been different in the hospital. No one wants to tell the mom in this case, “We gave you bad information, and led you to believe home birth was safe when it wasn’t. If you had given birth in a hospital, this wouldn’t have happened.”

      • RMY

        Just if she was hellbent on only allowing the interventions she did (ie not allowing a faster extraction than her pushing would allow after the epistomy if I’m understanding the sequence of events right) only within the timeframe they happened, then yes, it would’ve been the same.

        • Blue Chocobo

          If you limit your hospital’s tools to only the ones available at home, there really isn’t much point in getting off the couch.

          Hospital births are wasted on women who would refuse the available interventions that make hospital birth the safer choice.

          • AirPlant

            My SIL is an OB charge nurse and she likes to say that birth plans longer than a page or so they just go ahead and prep the OR. At a certain point if a patient won’t let you help them your only intervention left is the section when things turn sideways.

          • Gene

            Agreed. The birth plan with each of my kids was the same: healthy mom, healthy baby, Epidurals rock, husband wants to cut the cord if possible. I had three basically easy vaginal births.

            So, obviously, simple/short birth plan = simple vaginal birth.
            Natchrul birth plans > four sentences: yer doin’ it wrong!

          • Allie

            My birth plan basically said “I’d like drugs, opiate-based preferably, and I have no problem with a precautionary IV line”. They didn’t do the precautionary IV line and ended up having to jam it in in a mad panic when I had a PPH. Also, due to precipitous labour, I didn’t get the opiates until AFTER I pushed her out. It’s a turvy-topsy world!

          • Bombshellrisa

            My OB office has a template for a birth plan that covers every possible thing to the point that it frustrated me. My wish list was not long, it said I wanted an epidural (precipitous labor so I didn’t get that) and I wanted an IV started by the person who could find a vein in a turnip (I am a hard stick). The rest–lights, music, ect–were determined in the moment so I ended up watching “Moonrise Kingdom” while I delivered. I would have been fine with any intervention, I guess I am just too lazy to be a control freak in labor,

          • Dr Kitty

            My birth plan raised eyebrows this time around.

            It basically said that our desired birth was a CS, in the event labour started spontaneously the plan was for epidural and CS ASAP, and there were no foreseeable circumstances where VBAC, augmentation of labour or instrumental delivery would be acceptable to me.

            In the NHS the expectation is that you want to try for a VBAC if at all possible, and certainly if you go into labour spontaneously.

            I had one midwife who was obviously not happy with my preference, but my explanation that I’d seen too many obstetric disasters as a junior doctor to be happy with anything other than the plan which optimised my baby’s brain function and my pelvic floor shut her down.

            Thankfully baby stayed put and everything went perfectly to plan.

          • Montserrat Blanco

            I did not have time to write a birth plan!!!!! I even did not attend the birth lessons!!!! And somehow I still ended up with a healthy preterm son and without any long lasting complication myself.

          • Tigger_the_Wing

            Just like me, with my first. He arrived, three weeks early, on the Saturday before my first scheduled birth lesson; they were only held a couple of times a year, and I’d missed the previous set, not knowing how to find out where they were. No internet in 1981.

            When the midwife asked me what my birth plan was, I told her “To do whatever you tell me to do, whenever you tell me to do it.”

            I don’t think I’ve ever seen anyone look more relieved.

            Apart from neonatal jaundice, and a brief no-breathing episode before they could get him under the lamps (they only had one set, and they were in use), he was fine.

            I got him breathing again by reflex – before modern anæsthetics, rabbits would often stop breathing, and I’d resuscitated them more times than I can count. He’s now 34 and a father himself. And a concert pianist, and orchestral tuba player.

            I used the same ‘birth non-plan’ with all my subsequent births.

            And brains are remarkably resilient. At three months, one of my twin boys had a huge fluid-filled space in the centre of his brain (he had a scan because his head was so large); the neurologist said that he would not be able to tell how much damage there was until he was older.

            A subsequent scan six months later showed a normal brain – the fluid had been absorbed, or had drained away, and the compressed brain tissue had sprung back into place.

          • Amy

            Most of my “birth” plan was actually post-partum stuff! I had something in there about no visitors unless they were on an approved list (because my relatives kept showing up unannounced and really unwanted after my first kid), and they had to ask all those mandated questions about whether someone was stalking me. Good times!

  • yentavegan

    Sure this mother thinks she had a positive birth experience. She was given gas/air by the midwives so she did experience reality through the haze of a mind altering substance. Instead of gas/air pain relief , the mother/baby would have been better served by a fetal heart monitor.

    • fiftyfifty1

      A fetal heart monitor is helpful for detecting fetal distress before birth, but this was a shoulder dystocia, which is different. What is helpful about the hospital in a shoulder dystocia is all the trained people to help with the maneuvers (HELPERR) so that the baby gets out sooner than 4 minutes.

  • Amy M

    I read this story via Facebook yesterday, and it seemed like this woman was in the UK or Aus, using NHS midwives at home. If that is the case, a chunk of this disaster rests on the midwives’ shoulders: the baby was 10lbs, did anyone do u/s to estimate the weight? We don’t know if the mom was counseled about the risks of having a big baby vaginally (and at home). It seems, from the story, that they called an ambulance right away at the first sign of trouble, but even with integrated homebirth, that’s always the limiting factor—the time for an ambulance to get there and then get to the hospital.

    However, the mother’s attitude—that she did the right thing for her “happy, healthy” girl, is weird. I agree with what lilin said below, that the mother has to tell herself that story, but what about the medical professionals involved? Since they are actually medical professionals, they should (and maybe they did) tell her that if she has any more children, it should be in a hospital.

    • Stacy48918

      This exact point was made by Amos Grunebaum in one of his articles. When brain function is in the line EVERYWHERE is too far away. Any distance is too far away, even in the best integrated system.

      • Amy M

        Oh I agree, but with an integrated system, that should be pointed out to the parents. And we don’t know from the article, maybe the midwives did say something about it, but yeah, its all fun and games until someone doesn’t have enough oxygen.

    • Roadstergal

      If my UK friend is any indication, the woo-friendly midwives there do an awfully good job of selling a bill of goods to women already inclined, even a little, in that direction. Hospitals are bad, women and babies get infections there, babies die. Everything that can be done at a hospital can be done at home, in a more nurturing, relaxing environment. OBs are just surgeons who want to give you needless C-sections. It’s not their fault, they just don’t know how to work with normal birth. Look, the Birthplace study showed that homebirth is always safer.

      She’s currently post-dates for an HBAC (with no prior successful VB), as per her Twitter, and the midwives are reassuring her that everything is fine, she’ll have a beautiful, healing birth in the rental pool when the time comes.

      • Sarah

        Some of them definitely do. Not all, not by any stretch of the imagination, but enough.

        • Roadstergal

          Oh, I totally agree, I didn’t mean to imply that they were all like that. Just saying that the ones who cared for this woman might have been.

    • Joy

      In a normal pregnancy there are only two scans at 12 and 20 weeks. So unless there is an issue there wouldn’t have been another to estimate weight.

  • shobbie

    I’ve been reading the Skeptical Ob for years now. This one was very hard for me to read. The description of what happens during oxygen deprivation… is gut wrenching.

    I just had had my fourth child 4 months ago. I have had 3 uncomplicated vaginal deliveries, 2 with epidurals, 1 without. Easy peasy, the only difficulty being deep 2nd degree lacerations that were pretty uncomfortable to heal with.

    With this last baby, my water broke first, which has never happened before. So, we went to the hospital, got hooked up to monitors, and after a few hours with no contractions, they started some pitocin. Then, I got my epidural. My blood pressure dropped which is typical for me. But then, they couldn’t get it to come up and stay up. Then I started to bleed. And baby started started to have late decels. He dropped to the 60s, and then came back up. Next contraction, to the 50s. I knew and that point it was probably going to be a csection. I had terbutaline to stop things for an hour and baby was great the whole time. Then, when it wore off, the next contraction he was in the 40s. He recovered back up to the 140s, but it was time for the csection. He He was out about 20 minutes later.

    During the surgery, I heard my ob say “we have an abruption” and everyone started to move very quickly. I wasn’t doing well myself, my blood pressure was still not staying up, and the anesthesiologist had to push epinephrine 3 times. The anesthesiologist spoke to the ob and told him “I think we need to be concerned about an amniotic fluid embolism here.” Unfortunately for me, I actually knew what that was, and started to panic. I was worried I was going to die. Fortunately, he was wrong. Once I was closed up, I had no further problems.

    My baby, unfortunately had been low on oxygen for a while. His initial pH was 6.98, which had everyone very concerned. He was absent suck, Moro and swallow reflexes. No seizures. We delivered in a hospital with a level III NICU. They immediately had him out the door and to a room. He was dagnosed with moderate HIE. He underwent 72 hours of total body cooling. He had around pulmonary bleed that was missed for about an hour because he had aspirated my blood, and they didn’t realize he was actively bleeding. They controlled that, but unfortunately he needed to be on a ventilator. Once he was warmed, and weaned from the vent, he had a his MRI. It came back normal, thank goodness. Once he was eating well, we were discharged after total of 9 days in the NICU.

    The pathology report on my placenta confirmed a partial abruption. It was approximately 50% separated when he was delivered.

    He is 4 months old now, and all of his developmental screenings had been normal. He’s my happiest, most smiley baby. He giggles at his big brother and sisters. He sleeps well, and likes to roll around. I know that we can’t know that he’s ok. But if we had been home, he’d be dead. I may have been dead too, leaving my older children without a mother, and my husband a widower. I’m so grateful for good medical care, and I don’t understand why one would choose to go without.

    • Megan

      Wow, what a harrowing experience. I’m glad you are ok and that so far, your son seems to have escape unscathed.

    • Roadstergal

      Oh god, what a story. I’m so glad you both were in good hands and came out of it okay!

    • Oh my, what a story. It sounds like you were in good hands.

    • Allie

      “all of his developmental screenings had been normal. He’s my happiest, most smiley baby. He giggles at his big brother and sisters. He sleeps well, and likes to roll around” = AOK if you ask me.

      The brain is a mysterious and miraculous thing, and what we know about it is vastly outweighed by what we don’t. You did everything in your power to ensure his safe delivery and good health, and it sounds like you succeeded.

      • shobbie

        Thanks. Even if he does have some delays down the road, I prefer that to no baby at all.

        They call me… Mr. Smiles!

    • Amy

      Wow. That was gut-wrenching to read. So glad you’re both doing well!

    • Mishimoo

      Oh wow! So grad you’re both doing well and that you were in good hands for the delivery (and afterwards!).

    • Amazed

      What a story! So glad you both escaped!

    • Montserrat Blanco

      I am so glad you got appropiate care! Best wishes and hopes for your son!

  • moto_librarian

    If she’d been in a hospital, the NICU team would have been paged the moment that it became clear that there was a shoulder dystocia. There would have been multiple people available to do maneuvers to get Poppy unstuck. I sincerely doubt that four minutes would have been allowed to pass from the point of the episiotomy to delivery in a hospital. Of course, had she been in a hospital, they likely would have been pushing for a c-section well before things deteriorated to this point.

    Her child is one. She should report back when Poppy starts school and let us know if she has any learning deficits. It would be quite surprising if her baby really has absolutely no lasting effects from HIE. Personally, I would have a very hard time explaining how I was more concerned about my birth experience than my child’s brain when said child starts asking questions.

    • JB

      But even if the baby ended up with no neurological issues: according to natural birthers, it is imperative that baby nurses immediately, is not hatted, has non-stop skin-to-skin – but this baby spent days in the NICU instead…

  • The Bofa on the Sofa

    ” she tried to brain her blood pressure to get more blood to her brain.”

    Not sure what that means. Probably a typo

    • Amy Tuteur, MD

      raise her blood pressure

      Thanks. Fixed it.

  • Jenny_from_da_Bloc

    Yeah everyone would have panicked and saved her daughter from a life of misery instead of just calmly doing nothing or crowd-sourc ng for medical knowledge on FB. Her daughter would not have suffered HIE in the hospital because they would have acted promptly and got her put or realized she was a large baby and offered her a C-section, but vaginal birth was more important than her daughters life.

  • Zornorph

    What I don’t get is how this woman still thinks she had a ‘beautiful birth’ when she admits that it gave her PTSD! I mean, she’s describing how her husband and midwives had to ‘drag her across the room’ and then cut her without any pain relief. In what world is that ‘beautiful’? I get why some women get this image of votive candles, new age music and laboring in their bathtub and think that’s beautiful, but that’s not even close to what happened here. It sounds like a horror show.

    • lilin

      It’s just a necessary denial of reality. What else can she say?
      “I wanted a perfect homebirth with no interventions and a healthy baby so I took a risk. I ended up getting interventions, was in agony, and my kid got brain damaged. I made the wrong call and lost everything I was hoping for.”

      It has to be a “beautiful birth” because otherwise it’s just a total and complete fuck up and that can’t have happened.

    • sdsures

      It’s martyrdom.

  • Daleth

    I’ve asked this same question so many times. It’s just idiotic. If my baby has gut-flora problems, I can give him probiotics. But what can I give him to fix his HIE? NOTHING AT ALL.

    • Megan

      Yes, I was thinking about this yesterday when NPR did a story about the gut microbiome of newborns and said that we need to increase breastfeeding or decrease csection rates to improve that. It is so easy to change the flora of the GI tract; in fact, Your microbiome changes even with dietary changes. So instead of maligning csections or further demonizing formula feeding, why don’t researchers look into what gut flora are associated with less disease and find out the best way to cultivate them? It seems that the media, NCB devotees and lactivists have fun with the gut microbiome thing before we even have the whole story.

      • Roadstergal

        We don’t have close to the whole story. What story we have is:
        -There are a few ‘bad’ microbiomes.
        -There are a whole massive diverse lot of perfectly good ones.

        Someone had better have some really, really strong evidence that differences between C-section and VB microbiomes, or FF vs BF, are clinically meaningful, and not just two iterations of perfectly good ones. Because it looks like the latter, to me.

        • Roadstergal
        • Megan

          Yes that’s what I figure the true outcome will be. That’s why the NPR story made me mad. I wanted to comment on it but I really don’t have enough knowledge of he topic to do so. All I knew for sure is that they were putting the cart before the horse in order to preach the same old propaganda. Thank you for your explanation.

      • MaineJen

        I heard that story too, and I would have been head-desking in frustration had I not been driving at the time. 🙂 “Increase breastfeeding.” “Decrease c sections.” I wanted to scream “Which particular c sections would you say were unnecessary?”

      • sdsures

        There was a BBC article about this. I posted it on FB and got the requisite tune of “don’t demonize breastfeeding or natural birth”.

        Sigh. https://www.facebook.com/stephanie.briggs3/posts/10153032458736851?pnref=story

      • Sarah

        We don’t even have evidence that making a CS, ff baby’s gut flora more like that of a VB, bf one would constitute an improvement. All we know is that there’s a difference.

        • Daleth

          Exactly. We don’t know what constitutes optimal gut flora. We also don’t know that having gut flora similar to your birth mother’s vaginal flora is necessarily even always a good thing, since women’s vaginal flora is diverse and presumably not every combination of flora is “best.” And obviously if mom’s vaginal flora includes GBS, that’s clearly a bad thing.

          And we do know that what constitutes someone’s ACTUAL gut flora changes quite easily–add antibiotics or probiotics to the system and bingo, it’s different than it was yesterday. So assuming we eventually determine that XYZ combination of flora is optimal, we can put it in babies’ food and create the optimal gut environment easily.

  • sdsures

    Sounds to me like Poppy’s mom is fishing to be the mommy who tirelessly cares for a possibly-disabled child, forsaking her own comfort. This would turn Mommy into a “hero”.

    • lilin

      Should coin a term for it: Munchausen by Homebirth.

      “I sacrificed my life to care for the child I gave brain damage to but don’t pity me because I don’t regret a minute!”

      • Lizzie Dee

        I think there is a difference between “risking” brain damage out of the over-optimistic assumption that it doesn;t happen to “natural” supermums, and “giving” brain daamage – and your rather contemptuous assessment of mothers who care for a disabled child is a bit harsh!

        The potential consequences of a relatively short time of being deprived of oxygen are rather hard to appreciate in abstract terms – and if a child is born in hospital with good, fast, neonatal care, may never be all that apparent. And, actually, no-one is that keen on linking difficulties at school with the circumstances of birth!

        As with most other complications of birth, the real need is for a far more realistic attitude to those risks, instead of regarding a natural birth as some test of womanliness.

        • Kelly

          I think she is only talking about the mother’s who stunt birth in order to get attention. They can now get attention through a sick child.

    • demodocus

      My husband’s grandmother was like this, only with her poor disabled grandson. She’d make up extra illnesses (like cancer) for him, because being just congenitally blind wasn’t enough. Fortunately, MIL shielded her boy from the worst of it, but even when we were dating, Grandma tried a bit of that. She told me to butter his bread and cut his meatballs at a restaurant once. I couldn’t even figure out what she was saying for a minute. Finally she made her new husband do it. Demodocus didn’t want to make waves and confront her about it.

      • sdsures

        Pretty sure blind people can cut up their own food and butter their own bread. 😛

        • demodocus

          Since I’d seen him doing it in the college dining hall dozens of times by then, um, yeah.

          • sdsures

            Heck, I don’t have any vision problems, and a couple days ago I stabbed myself with a fork! The injured hand was, thankfully, OK.

    • indigo_sky

      Sounds to me like she’s a loving mother doing her best to make peace with a traumatic experience.

      I think it is important to note that this appears to have happened in the UK. This was not a mom avoiding the medical establishment by hiring a rogue CPM (not to imply that there are CPMs that are not rogues). She as following medical advice and birthing within the established national medical system.

      I believe there is a good chance that having a team of medical professionals helping instead of a pair of midwives and a scared husband could have gotten the baby out faster, and/or that having a nicu team paged to her room could have helped baby. No way to know absolutely for sure (except, probably for sure if she’d been advised to have a csection and done it), but like I said, a good chance. (On the other hand, happened in the US with a CPM, I am absolutely certain baby would be either severally disabled or more probably dead).

      However, I can see from her point of view with having midwives with the same training/skills whether she is at home or in the hospital, and the midwives do bring life saving equipment, and I am assuming it was probably a very fast transfer to the hospital, I can understand how she could convince herself (and maybe has been told by medical professionals too), that there would have been the same outcome if she had delivered in the hospital.

      Cases like this where we see just how quickly things can turn very bad show the importance of having teams of experts and often more equipment/medicine/blood on hand than can be brought to a home. But please let’s not be too harsh in dealing with a mother who was doing her best and following the advice and acting within the standards of the medical system where she lives.