VBA3C homebirth: ruptured uterus, brain damaged baby

In December CNN published a story that received a lot of attention and approval among homebirth and natural childbirth advocates, Mom defies doctor, has baby her way. Mom, Aneka, made the decision to risk her life and the baby’s life based on the flimsiest of reasons, she watched Ricki Lake’s documentary, The Business of Being Born.

She found support for her decision from ICAN (the International Cesarean Awareness Network):

“She asked me if I could find someone who would deliver her vaginally,” remembers Bobbie Humphrey, who works with ICAN. “She started to cry because she’d heard ‘no, no, no you can’t do this’ so many times.”

But Humphrey told her yes, that she knew of a midwife who would be willing to deliver her baby at home.

Aneka and her son were lucky. They survived her risky choice, but Aneka and her on line supporters had no clue it was just a matter of luck:

“People were e-mailing Aneka saying ‘congratulations, you’re a role model,” Humphrey says.

Another woman did try to emulate her, with tragic results:

A girl who I went to college with had a baby around 10 last night & both are in critical condition. This is her 4th baby. She had 3 previous c-sections & was trying for a VBAC homebirth. Her uterus ruptured in several places & she lost a lot of blood. She is intubated & had 2 blood transfusions. She isn’t out of the woods yet, by any means. The baby was born blue & unresponsive, was resusitated, but showing signs of possible brain damage. She was flown to a different hospital than her mom. The baby is being kept in some sort of induced unconscious state currently. Please keep Lori & baby Vera in your thoughts & prayers!! Thanks.

Apparently Lori transferred to the hospital at some point during the homebirth attempt. Her sister-in-law wrote on her personal blog:

… Lori lost a lot of blood because the uterus tore in several places; the docs had to replace her blood twice over. She has been in the OR at Lehigh Valley Hospital from 10pm (1/27) til now 4:20am (1/28). When I left the hospital at 4:20am, the OR team was just finishing up. I was not able to see Lori or the baby. Right now, Lori will remain intubated for the next couple of days, and in the ICU. The doctor said she is not out of the woods, she is still critical, and has a long road to recovery.

Baby Vera is also having difficulties… Somewhere in the process of removing the baby, she lost oxygen. She was born blue and flaccid and needed resuscitative measures. She pinked up and her heart rate became strong, but she remained unresponsive and could not breathe on her own. Vera was medivaced via helicopter to Jefferson Hospital in Philadephia for a cooling process. The docs are hoping that by placing Vera’s brain and body in a slightly hyperthermic [sic] state, that her little body will reset. She is responding to pain, but her pupils are still not dilating. Vera is also considered critical.

Lori’s friend posted updates on the message board:

Lori is doing better. Her blood work, urine output, and vitals signs are strong and look good. When the nurses lighten her sedation, Lori is fighting against the breathing tube, which is a good sign (she knows it’s there)….

Vera, however, is not doing as well as the doctors wanted. She has little brain activity and her pupils remain unreactive. She is still intubated and in critical condition. They have her doing the cooling treatment and will be on it for 72 hours…

Update 1/29:
Lori is doing much better – breathing & talking on her own. She still has a long recovery, though.

The doctors are trying [cooling] treatment with baby Vera. The treatment is 3 days, then it’s just watch & wait to see what happens.

All of this leaves me with questions for the folks at ICAN who encourage women to take these life threatening risks:

Will you use Lori as a role model for VBA3C? Or will you wash your hands of her and pretend this never happened?

Update (2/3/11): According to the neonatalogists “…the MRI showed that a large amount of fluid had collected (hydrocephalus) and was putting pressure on parts of the brain, actually moving sections into different areas (herniation). The EEG showed minimal electrical activity from the cerebral hemispheres. The neurologist stated that there is some brain swelling as well as significant brain damage in a large part of her brain, but she is NOT brain dead. Vera still has some reflexes. What they believe Vera has is HIE, Hypoxic Ischemic Encephalopathy.”

Update (2/12/11): Vera died last night.

  • Molly B

    The parents hired the midwife plain and simple

  • Molly B

    C/S even of a healthy mom can results in death from blood clots, anesthesia mishaps, severe bleeding due to lacerations etc.

    • And vaginal birth in a healthy mom can result in death from hemorrhage, infection, retained placenta, and so forth too. A C/s has a very tiny increased chance of complications for mom, and a decreased risk for baby, over vaginal birth.

      You gotta present both sides, Molly B.

      • Molly B

        The risk of maternal mortality increases with each cesarean section. It also has increased risks of morbidity to mom and baby, including an increased risk of the need for neonate mechanical ventilation

  • Molly B

    Unless you cant find an OB willing to allow a TOLAC!

    • Monkey Professor for a Head

      Why do you think an OB might not allow a TOLAC? Because they’re big meanies? Because they hate vaginal birth? Or because they may not have the resources to save a baby’s life in the event of a catastrophic uterine rupture?

      • Robin Stewart

        Another reason is because their malpractice insurance will threaten to cancel on the doctor if they do try.

        • Amy Tuteur, MD

          Why would an insurance company do that?

    • Azuran

      Because a TOLAC has risk and in order to do one safely you must have the proper equipment to treat any possible complication. If you have a TOLAC in a hospital that is not equipped to deal with a uterine rupture, both the mother and baby could die.
      You might have to travel a bit for this, I know it sucks, but it’s life.
      When my mom had surgery for her bain aneurysm, we had to go to a hospital 6 hours away. Because the location of her aneurysm was special and her treating neurosurgeon knew he wasn’t equipped to deal with complications in her case if one arrived. So he referred her to another specialist in a bigger hospital that had the equipment. There was no complication, but do you think the first doctor should have still done the surgery?

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  • J_in_the_Lou

    What are your thoughts on a VBA3C in a hospital setting? I am particularly interested in comparing VBA3C to CBA3C.

  • CoyoteFL

    Sheila, if you happen to get this… I’d love to talk with you. I’m a mom with 3 prior C-sections considering VBAC. I’d love to do it in the hospital because I’m afraid of the complications that could arise and not being in the hospital, but there are NO providers that will allow a VBA3C in my area! In fact, there are only 2 providers that allow VBAC after 1 prior cesarean and that is only if you meet all the criteria on their list… it’s ridiculous. DeFacto ban for sure.

  • JulieBeth

    A rupture is very rare but generally only happens during labor. Post dates doesn’t mean the baby is too big, it means she was past her estimated due date, and that is not a dangerous thing, statistics prove this out. Ever state has different homebirth laws, in many states midwives who are not CNM can practice legally, and a trained midwife is a safe birth provider regardless of the law. Doctors cause birth damage all the time, and they can only do so much to prevent complications. Each mom has the right to choose the birth option that is best for her. This same scenario could easily have happened if this was a planned hospital VBAC.

  • JulieBeth

    This same scenario could happen at a hospital birth. I had a doula client whose child lost oxygen because of the nurses unwise decision to cut the cord and stop all oxygen through it before beginning resuscitation. A ruptured uterus doesn’t show until blood shows or BP drops. Trying to infer that VBACs at home are dangerous because of one complication is foolish. The statistics show it is safe, midwives know when to transfer. Their good birth outcome statistics are better than hospitals. If hospitals had better birth policies more women would choose them but doctors like you who are alarmists keep that from happening.

    • Amy Tuteur, MD

      No, that’s NOT what statistics show. They show the complete OPPOSITE. But if you feel otherwise, don’t hesistate to provide us with the statistics from peer review scientific publications.

    • An Actual Attorney

      Even I (barely passed HS bio) know that “A ruptured uterus doesn’t show until blood shows or BP drops.” and “doula client whose child lost oxygen because of the nurses unwise decision to cut the cord and stop all oxygen through it before beginning resuscitation” aren’t factual statements.

      Hints –

      1. Hospital VBACs are continuously electronically monitored, why do you think that is?
      2. Where do you think the O2 come from if the placenta isn’t attached to anything?

    • Dr Kitty

      Hint, if the nurse wants to resuscitate the baby, it rather suggests the O2 from the placenta isn’t getting through in the first place.

      • Molly B

        And decreased O2 can also be caused by decreased maternal BP not allowing enough O2 to placenta which can be caused by epidural. Known fact.

        • Nick Sanders

          Cite it.

    • The Computer Ate My Nym

      The statistics show it is safe, midwives know when to transfer.

      Which statistics would those be? Dr. Tuteur’s showed quite a lot of statistics that demonstrate the opposite. What do you have to counter hers?

      • Trixie

        And even if the midwife identifies a potential rupture in time, it’s going to be too late to get to the hospital and avoid disastrous consequences to the baby. You’ve got about 15 minutes to get that baby out at most.

        • Molly B

          Even with an epidural in place in can take 10-20 minutes before full effect is reached. My mom in law in a NeoNatal NP at a level 3 trauma center and says that Moms and babies die with or without medical interventions at hospitals.

          • Nick Sanders

            Yes, mothers and babies still die even with all the treatment available in hospitals, but far fewer do so. And we have more than just one anonymous person’s word on that, we have published statistics.

            I have to ask, why are you grave digging with all these repeatedly refuted talking points?

          • Molly B

            I’m not sure what you mean by the term grave digging. As for the far fewer die, that’s debatable. It’s a yes and no. Compared to the 19th century yes far fewer moms and babies die, but the US has one of the highest mortality rates for moms and babies of any developed country. This should not be happening. The death rate has also.increased with the cesarean rate. These are not anonymous claims, these are facts that anyone can find through reputable, medical sources online.

          • Box of Salt

            Molly B “These are not anonymous claims, these are facts that anyone can find through reputable, medical sources online.”

            Please post links to your sources.

          • Box of Salt

            Molly B “I’m not sure what you mean by the term grave digging”

            What’s the date on this post?

            Please note that this site does not (usually) close comments after a specified time period – they remain open indefinitely.

            Perhaps you could comment on a more recent post?

          • Molly B

            The comment makes sense now. Thank you.
            I commented on this post because while researching my birthing options I came across this article. Like me, any mom or person who inserts the right query could come across it as well.
            Because women should be able to view a variety of opinions to aid in their own thought process and research to find the facts.
            Because this is America and I can, regardless oof your judgments.

          • Who?

            It’s great you’re looking into options for yourself and your baby. Remember though if someone is promising you a guaranteed outcome, they are, by definition, lying.

            As your mil pointed out, mothers and babies die in hospital as well as at home. In hospital, there is a team of people who are highly skilled in specialties devoted to the care of you and your baby. At home is a hobbyist working alone or with other hobbyists.

            It’s your right to do your research. It’s your responsibility, as a parent, to do the best for your child. That means seeking high quality, accountable medical care.

          • Molly B

            I agree completely.

          • Molly B

            I agree completely

          • Nick Sanders

            I’m not sure what you mean by the term grave digging.


            Compared to the 19th century yes far fewer moms and babies die,

            Compared to birth outside the hospital, too.

            but the US has one of the highest mortality rates for moms and babies of any developed country.

            We have a high death rate for babies >1 month old. For <1 month, including delivery, the rate is actually quite low.

            If you want to compare deaths of mothers, I'll need a bit of time to look up the numbers.

            The death rate has also.increased with the cesarean rate.

            Citation please.

            These are not anonymous claims

            “My mom in law in a NeoNatal NP at a level 3 trauma center” is absolutely an unverifiable anonymous anecdote.

            these are facts that anyone can find through reputable, medical sources online.

            Then do so. It’s your responsibility to back your own claims.

          • Molly B

            but the US has one of the highest mortality rates for moms and babies of any developed country.


            The death rate has also.increased with the cesarean rate.


            The reference to my mother in law was not to say she was the specified source for my claims, only that she works in the hospital and stated that death happens with or without medical intervention.

          • Nick Sanders

            Neither of those backs your point. In your first link, check out the chart of “Causes for pregnancy-related deaths in the U.S.”. Anesthesia complications comes in dead last of the causes listed, at a rate so low it’s rounded to 0%. To compare, the next cause up comes in at 5%.

            As for the second, I’m guessing you didn’t read it.

            Conclusions and Relevance
            National cesarean delivery rates of up to approximately 19 per 100 live births were associated with lower maternal or neonatal mortality among WHO member states. Previously recommended national target rates for cesarean deliveries may be too low.

            And then there is figure 2:

          • Molly B

            Causes of pregnancy related deaths?? Look at the time frame of gestation for.the article. This article is including ANY death THROUGHOUT pregnancy and for a certain length of time after the end of a pregnancy. Show me a stat on death in childbirth in the US

          • Nick Sanders

            Which might be worth talking about if you weren’t so hung up on epidurals.

          • Molly B

            The epidural increases risks to fetus which most doctor will opt for surgery to correct therefore surgery risks are linked to side effects of epidural.

          • Molly B

            Anesthesia related deaths are those directly linked to anesthesia. The surgery has numerous other complications including dvt, sepsis, postnatal cardiac arrest (although I believe this is due to anesthesia) blood transfusion, unintentional laceration of organs, veins etc and the increased need for surgery as a result of epidural/spinal in relation to the complications previously sited such as hypotension and decreased oxygen supply to fetus resulting in low O2 levels and bradycardia. These complication increase the cesarean and since spinal anesthesia is typically an electiv

          • Nick Sanders

            Can you post any statistics on these claims at all?

          • Azuran

            Other countries with a high c-section rate do not appear to have the same problem as the US. Could also be because the US is one of the very few developed country where public healthcare is not a thing.
            Poor and underprivileged people who lack money or insurance do not have access to a doctor for preventing care before and during their pregnancy. They are therefore more likely to have complications and die.

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