Is a baby who dies during homebirth a person?

Advocates insist that homebirth is safe, but they don’t want anyone to look too closely. Hence the effort to resist coroner’s investigations by claiming that the a baby who dies during homebirth is not a person and therefore its death is not worthy of evaluation

The latest homebirth advocate to make this argument is Australian midwife Lisa Barrett of Homebirth: A Midwife Mutiny. Lisa is a vociferous opponent of Australia’s attempts to regulate homebirth, claiming that women have a “right” to give birth at home. What about the rights of babies injured or killed by homebirth? Apparently they don’t have any rights if the midwife can convince everyone that the baby was born dead.

The case is the typical homebirth tragedy, the kind that demonstrates that “trusting birth” is no substitute for emergency personnel and equipment. According to ABC News:

A coronial inquest has started into a home birth, but the coroner must first determine if the baby was alive.

The inquest heard Tate Spencer-Koch had a partial water birth at her parents’ home in 2007 but died from complications after getting stuck during the delivery.

Deputy South Australian Coroner Anthony Schapel must first determine if the baby was alive at birth and therefore a person under the law, before any full inquest can be held.

The court was told there had to be some sign of life, such as a heartbeat or a breath, once the birthing was completed.

All the ingredients for the typical “trust birth” fatality were present:

homebirth: check

birth pool: check

shoulder dystocia: check

midwife who didn’t anticipate the complication: check

absence of anyone skilled in expert resuscitation: check

Midwife Lisa Barret is claiming that the death should not be a coroner’s case because she was so inept at resolving the shoulder dystocia (40 minutes until delivery of the shoulders) that the baby died before the entire body was born. And because she was incapable of saving the life of an otherwise healthy baby, as opposed to merely rendering it brain damaged, she should escape investigation A news story explains:

… Common law holds a baby is alive, and therefore legally a person, if it has been “fully extruded” from its mother and breathes independently.

A 2005 NSW decision extended that definition to include babies who display a heartbeat or are breathing due to medical intervention.

This week, Mr Schapel was told Tate’s head was birthed 40 minutes before the rest of her body. Midwife Lisa Barrett said Tate never drew breath …

Unfortunately for Barrett, the paramedic reports that the baby did show signs of life:

… paramedic Alice Rowlands said officers detected electrical heart rhythms but no pulse.

Yesterday, Amay Cacas, counsel assisting the Coroner, said those rhythms were enough to justify an inquest.

“We have a fully-developed baby, a mother going into labour naturally and, right up until the head crowns, a good heartbeat,” she said. “Then, 40 minutes later, we have a completely unresponsive child with only the electrical rhythm.

“That rhythm means there is a possibility a heartbeat was present upon full extrusion, albeit weak or slow.”

The coroner accepted that argument:

South Australia’s Deputy Coroner will proceed with an inquest into a baby’s death during a home birth.

He has ruled the child was alive when she was delivered. Deputy Coroner Anthony Schapel ruled there was no evidence that the newborn took a breath or had a mechanical heartbeat when she was born.

But he ruled that electrical activity detected in her heart by ambulance workers after the delivery could be considered “the last vestige of her human existence”.

There are good reasons why a stillbirth should not be investigated in the same way as a neonatal death. However, that should not allow homebirth midwives to escape investigation simply because their mismanagement was so extensive that the baby died instead of being born alive and brain damaged.

In this case, the issue was mooted by the revelation that the paramedic found objective evidence that the baby was briefly alive after the body was born, but similar claims have been made in other homebirth deaths. The law should be amended to require investigation into any homebirth death that occurs in a baby with a normal fetal heart rate at the onset of labor. Otherwise, the more egregious the mismanagement by the homebirth midwife, then less likely it is that the mismanagement will be acknowledged and remedied.

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