Classic homebirth midwifery screw-ups

For every incidence of preventable death at homebirth that are write about, the are many more near misses, but even I was surprised to find two separate examples on the same day. The first is almost a parody of homebirth midwifery ignorance and irresponsibility, but no one was in any real danger. The second was gross incompetence that easily could have resulted in the death of the baby if the mother had not insisted on going to the hospital. Interestingly, she had no idea how thoroughly her midwife had failed her.

The first case is I let go of my self-righteousness and had a Cesarean delivery — and I’m thankful for it. I have to give the folks at Offbeat Mama credit for publishing it at all even (or perhaps especially) with this caveat:

We hope it goes without saying that we LOVE midwives and home birth on Offbeat Mama. That said, some home births don’t go as planned and no health care practitioner is infallible, and we want Offbeat Mama to be a place for those truths, too…

Rachel, the mother, writes:

When I got pregnant last January I was stoked about the joyful, carefree unassisted birth I had always dreamed of. My husband and mom, though, were concerned about the safety of freebirths and so I compromised with them and hired a Certified Nurse-Midwife who only did home births… When I caught her voicemail, I noticed she signed off with “Namaste.” I thought: “Wow, this is going to be so great! She’s just like me! I don’t have to worry that she’ll force me to have medicines or procedures done that I don’t want.”

Then the near parody continues:

I don’t want to go into the gory details of my labor, but I will say that it lasted 92 grueling hours. My mom and dad holed up in the spare bedroom, crying; my husband held me and the baby’s godmother poured me wine and stroked my hair to try to help me sleep when I had been awake for the first 48 hours…

And what was the midwife doing all this time? Knitting! I kid you not. Well, that’s what she was doing when she was actually there.

My midwife kept coming and going; she would drive over and check my cervix, which dilated excruciatingly slowly. She would leave afterwards, telling me in none-too-caring tones that everything was “normal” and that every other woman in the room had gone through this, so there was no reason I shouldn’t be able to handle it…

At one point she felt my cervix and told me I had reached eight centimeters, and that she’d check me again in two hours. When the two hours were up, I asked if she would do it again. She said there was no need (she was knitting a scarf serenely on my floor). “Do you feel like you need to push? Then push.” I did, but nothing happened.

So much for homebirth midwives who stay with you throughout labor.

Finally, Rachel decided to ignore the midwife and head to the hospital. Imagine her surprise when, contrary to what she had been told, the doctors and nurses were caring and supportive:

Once at the hospital the nurses, anesthetists and doctors were more than kind. The head nurse held me close to her while I got the epidural I dreaded, and I was able to sleep for the first time in days. The obstetrician told me I would probably be able to have the baby vaginally, but that my midwife had lied to me — I’d never passed seven centimeters. The baby was “sunny side up,” presenting the wrong part of her head downward. After a few hours it became imperative that I have a Cesarean section: I had a fever and Baby’s heart was starting to race.

I was terrified. The anesthetist cradled my head as she held the gas over my face, and crooned to me in Afrikaans. Long story short: Rowan was born, and she was perfect.

There was an interesting little coda to the episode:

A few weeks after she was born, a representative from the Commonwealth of Virginia showed up at my door. Turns out, my midwife had let her license expire a while ago, and that was why she disappeared when I wanted to go to the hospital. I never had to appear in court, but I was interviewed for the record.

The second midwifery screw-up was published on a different online magazine, also for women who pride themselves on being different. The article is entitled Home Birth to the ER: A Life Changing Personal Story. Chiara’s son easily could have died from a classic childbirth complication, and although Chiara understands that this was a near miss, she apparently did not understand that her midwife screwed-up in the worst possible way.

Chiara was never an appropriate candidate for homebirth because of a pre-existing medical condition (beta-thalassemia), but:

… After watching The Business of Being Born, Jason and I decided we were having a home birth. We were 4 months in, and we found Gracefull Birthing in LA. We quickly fell in love with the two midwives…

Chiara’s pregnancy was complicated by a hospitalization for premature labor, but she made it to term.

The night before the 37th week began, I went into labor. I was calm. I was prepared. I had watched videos of African women having babies to learn what labor was like, unaffected by society’s perception of the experience. They hardly made a peep. We called the midwife with 7 minute contractions at 10pm. By 12am, we called back with 3-4 minute contractions. By 1am, they were 1 minute apart. My midwife and her assistant arrived. This is when everything fell apart.

Her labor was abnormal:

I was handling the pain, but [the contractions] were coming quicker than normal. My midwife measured me, 1.5cm dilated. She told me to get into the shower to relieve the pain, so I quickly undressed and hurried to relief. I was only able to stay up for about 4 minutes before I felt sick, so I called Jason in and that’s when I started to bleed. The midwife ran over, listened to Luca, and measured me at 4cm. It took less than 15 minutes for me to dilate 2.5 cm. I laid down for 30 mins and they blew up the tub. “You’re having a very fast labor.”

The pain was damn near excruciating. My contractions were back to back with about 4 seconds of relief in between accompanied by bleeding, vomiting, and a knife stabbing feeling in my lower abdomen.

Vaginal bleeding, abdominal pain, rapid uterine contractions, often coming one right after another: a textbook description of placental abruption. The midwife was completely clueless, but even Chiara recognized that something was wrong and insisted on going to the hospital. Imagine her surprise when, contrary to what she had been told, the doctors and nurses were caring and supportive:

… The OB knew I was in the middle of a home birth and instead of pointing her finger in condescension, she tried to deliver Luca naturally. I don’t remember much of the next 10 minutes. The doctor broke my water to stretch me the last cm, but I wouldn’t stop bleeding. I remember feeling Jason’s hand shaking, holding mine… I remember hearing the nurses around me buzzing about how pale I was and how much blood I was loosing… And then I remember…

.. Baby’s in distress. Prep the OR.

Fortunately, they got baby Luca out in time.

Chiara, though, has no idea that her midwife demonstrated gross incompetence in failing to recognize an obvious abruption. When I retweeted her story as an example of a midwifery screw-up, she responded:

I’d like to clarify something. What happened is not to be blamed on the midwife. She was very experienced, she just hadn’t seen placental abruption before. (Less than 1%) I genuinely believe it was because of our connection and her continued support that I was even able to communicate efficiently in a moment of crisis… After the delivery, she worked closely with pathology and the doctors on my case to find out more about what happened. She came over and we discussed symptoms, signs, and everything under the sun so that she would be prepared if placental abruption ever crossed her path again. It was an unforeseen emergency and the hippie ways of home water birthing and midwifery is NOT to be blamed.

Of course homebirth midwifery is at fault and ought to be blamed. The midwife demonstrated gross incompetence. She missed a life threatening major complication that was so obvious that even the patient recognized it. Any midwife who cannot recognize a life threatening complication when it hits her in the face is a danger to babies and mothers.

Both cases highlight the fundamental problem with homebirth midwives: the cult like belief that every deviation from normal, no matter how far it deviates, is just a “variation” of normal. But contractions one on top of the other, excess vaginal bleeding and precipitous labor are not normal. A 92 hour labor is not normal.

The most crucial skill for every birth attendant, indeed every health care provider of any kind, is the ability to distinguish between normal and abnormal. Any midwife who lacks the experience to recognize a major complication when she sees it, or lacks the wit to recognize a major complication because she has been taught everything is a variation of normal, should not be practicing at all.