How many times have we heard this story before?
Awesome homebirth midwife? Check.
I met the woman who was to become my midwife a week before I knew I was pregnant…
She brought so much joy to the pregnancy process and cheered us on in so many more areas of life. I had a great pregnancy and loved *almost* every minute…
Ignoring risk factors? Check.
But 42 weeks came and went, and though I was determined to let my LO come naturally … My midwife wasn’t concerned because I was a very low risk pregnancy, my water level was still great, and stress test results were just fine. Finally, on the eve of 42w+1 (or 42w+4 – I had 2 potential due dates), my waters broke …
Midwife with no idea until the moment of birth that the baby was in distress? Check.
My little boy wasn’t breathing. I held him as my midwife suctioned him, then laid him on the bed as she gave him breathes and started CPR. There was a heartbeat, but no breath…
High tech, extraordinarily expensive treatment to prevent further brain damage? Check.
The doc said 1 in 1,000 births result in birth asphyxia for unknown reasons (and the lack of immediate availability of resuscitation devices is why she doesn’t recommend home birth – something to consider) and that earned him the diagnosis of HIE (hypoxic-ischemic encephalopathy). He underwent an incredible treatment that put him brain into a hypothermic state for 72 hours in effort to stop brain cell death (from the lack of oxygen). He had had some seizures, so he was placed on two meds, one of which made him essentially comatose to the extent that they had to intubate him to keep him breathing…
Permanent brain injury? Check.
… The EEG came back clear and the MRI showed slight brain damage in the motor sensory areas of the brain. The neurologist explained that she has [no] of way of predicting how/if the damage will affect him longterm…
The result:
With the EEG clear, they took him off the sedating seizure med and were able to extubate him. Since he took well to my milk (given through a tube), we began to breastfeed on day 5 in the NICU. It took some work, but he started feeding well, and by day 8 we were headed home!
Just another gentle, no intervention, inexpensive homebirth.
Thank you for outlining the larger problem. For every stillbirth or neonatal death, there are an even greater number of neurologic injuries or other neontal morbidities. Is there any way to quantify this? If homebirth increases death by 2-5x, does neurologic injury also increase 2-5x?
Home birth and risk of neonatal hypoxic ischemic encephalopathy: http://www.ajog.org/article/S0002-9378%2813%2901604-9/fulltext#sec4 Risk of baby suffering HIE injury was 17 times greater in homebirth.
Dr Tuteur wrote about that extensively, so you should search older posts on this blog.
Getting back to the “youngsters today”/”relativism” schtick – I do think there is a growing trend towards relativism in our societies, including, maybe especially, in contexts where relativism is incorrect and/or immoral and/or dangerous. I don’t think it’s just young people being young, or young people being assholes, or young people being anything. Postmodernism and the accompanying rejection of “objectivity” has infiltrated just about everything, and it has brought with it a deep suspicion of science, rationality, empiricism, systematic philosophy and the life of the mind. It is a fundamentally regressive and anti-intellectual movement/ideology.
To give you just one example – I was at university in the late 1990s (and it was, for whatever it’s worth, a traditionally rather “prestigious” university academically) and I was in a distinct and frowned-upon minority for arguing that Female Genital Mutilation was morally wrong and eminently criticizable. A friend of mine (she now has two PhDs, both from excellent institutions) implied that I was a racist and colonial imperialist because I stated that your eye colour is dependent on the DNA in your cell nuclei WHETHER YOU’VE EVER HEARD OF DNA OR NOT (ie, DNA exists whether you believe in it or not). She actually tried to tell me that I have DNA (I am a pinkish-skinned Euro), but it was imperialist of me to claim that Australian Aboriginal individuals also have DNA.
It is almost impossible to fruitfully engage with that kind of level and depth of “fuck the truth” attitude.
I don’t agree that post modernism AS SUCH is to blame, nor that it is in itself anti-intellectual. I would agree that in the hands of the devious or the non too bright it can be used to defy common sense by replacing it with high falutin nonsense, and it is pointless to try and reason with those who use it that way. Interrogating the objectivity of observers doesn’t amount to claiming that there is no such thing as objective fact.
Challenging Authority is not in itself a bad thing – so long as it isn’t used to claim a spurious authority for a more convenient theory that sounds good. I think a bigger problem is that when a certain type appropriates the discourse of post modernism and finds themselves with a Ph.D, they then claim expertise in entirely unrelated topics -like childbirth, Postmodernism might have some quite interesting things to say about the way the dominant discourse comes to be framed – don’t think it would be terribly reliable on the way people react to risk – foregrounding the risks of things that are disapproved of, and minimising others. It might be a bit more helpful on the unreliable binary oppositions like natural/unnatural. In my book, there is nothing terribly natural about deaths or injuries of healthy young women, or an attitude that puts the value of a spurious experience over the life of a child.
So the neonatal and perinatal death rates are meaningless because we don’t know how many homebirth babies end up brain-damaged?
“The cascade of non-intervention”
” I attribute his fast recovery to both the amazing care we received from some of the top NICU med professionals in the world””
If some of the best monitoring and resuscitation in the world had been applied first, there might have been no need for all that technology later…
“Something to consider” indeed…
Horrendous story. OT a bit: I don’t understand why people enjoy sharing birth stories so much? Especially ones like this without the “happy ending”. It seems this over sharing of private medical detail on the Internet is very much in keeping with Dr Amy’s assessment of narcissism as being a key motivating factor in choosing home births for some.
It also looks like home birth has made it into the world of fiction here in oz. a woman called Kim Lock has written a chicklit book called ” Peace , love and Khaki socks” , set in Darwin and apparentLy chock full of home birth propaganda. In similar vein to “Melanie’s marvellous measles” for the antivaxxer crowd. I don’t know how well this book will sell, but I think it’s a sad reflection on the currency that these radical groups are gaining in mainstream culture. Too many terrible stories being told, both true and fictional!!
She says she wrote out the birth story mostly for her own “mental processing.” It sounds like she had a traumatic experience and is searching for resolution.
I realize that sometimes, for some people, it can be very therapeutic to sit and write things out. Hence, we have people who have kept diaries or journals. I really do understand that.
What I don’t understand is the need to share them with the world. You can write a diary or a journal without sharing it with others. In fact, that is kind of the whole premise to a diary, and is pretty common for journals, too. Yeah, you write, and it’s therapeutic, but it’s for your use. Putting it out on the internet for everyone to see? That’s a different story.
Note that Adelaide didn’t ask “Why did she write this?” Her question was, why share it?
I disagree with her assessment of narcissism, though. I think it is more about affirmation. The reason it gets shared is not so everyone can see what they did, but so everyone can say, “it’s ok, you aren’t bad.” This is why they have a fit whenever they discover that someone has the temerity to read their story and say, this person screwed up. The problem is not that she “uses their story without permission” or any of that nonsense, it is that she did not respond in an affirmative manner.
She said she wanted to share it “in case it resonates with anyone else.” I’m just referring to the original because that part wasn’t included here.
Often when people suffer a major trauma such as bereavement, disfigurement or serious illness they experience abandonment from their family and friends. They then seek social support from an online community of people in similar circumstances. When your online buddies are the only people who will talk to you any more, criticism for this quarter is like having someone spit in your face.
Single most chilling sentence: “My midwife handed me my little boy (! we didn’t know the gender until the birth) and that’s when my perfect home birth changed dramatically.”
No. Your son’s perfect homebirth changed dramatically when his body stopped receiving oxygen. And who knows exactly when that happened.
A wee digression. While reading this post I was struck by an urgent need to find out: When did “birth” become a verb? Here is the interesting answer from The Free Dictionary:
Regional Note: Until recently the use of birth as a verb meaning “to bear (a child)” has been confined to Southern speech: “Heap o’ good it do a woman to birth a mess o’ young uns and raise ’em and then have ’em all go off to oncet” (Marjorie K. Rawlings). Recently, however, the nonstandard Southern usage has coincided with widespread usage of verbs derived from nouns, such as parent, network, and microwave. Birth in this new usage is most commonly found in its present participial form and is used as an adjective in compounds such as birthing center.
So now midwives all over the US can say with pride: “I don’t know nothin’ ’bout birthin’ babies!”
UGGG just read the opening paragraphs of the aformentioned birth story and I had to stop reading.
This high risk mother,( yes you become high risk when you have no idea when your due date is) went for hours of intense contractions w/o fetal heart rate being monitored b/c she had to wait for the midwife to arrive 3 hours after labor started.
HEY LADIE next time around GO TO A HOSPITAL.
ok. read the whole way through. Um, did this homebirth midwife ever check the baby’s heart rate? Did I miss something? Where is the history of how well this infant tolerated contractions?
Not just low risk this time, but “very low risk”. Fancy that. And if you start low risk, of course no need to reconsider. (does any homebirth midwife ever identify anyone as anything else?)
As with all such narratives, lots of details left out. All as serene and happy ever after as this kind of story requires. This mother believes she was blessed not to have a clue of the seriousness, and maybe that is true.
This is the thing that jumped out at me. “Very low risk” at 42 weeks? How can that be?
I suppose that in NCB terms, she was low risk – easy birth, no complications, pity about the baby.
Anyone see this article? http://shine.yahoo.com/parenting/home-births–5-things-nobody-tells-you-212656269.html
I can think of two things wrong with the AAP statement: #1, the pediatrician’s malpractice coverage may not cover a home birth. #2, I doubt most people could afford the pediatrician’s pay (much like the “ambulance on standby” argument.
And I love how she says that homebirth isn’t messy because she has a partner that loves her. SOMEONE has to clean. That’s the whole point.
Dr Amy, I`m wondering if you could someday do a post on the actual *cost* of these homebirth shenanigans.
Homebirth devotees often argue that it should be accepted or even promoted because at first glance it is cheaper than hospital delivery. We see this line of reasoning not only in the US, but also in the UK, Canada and the Netherlands. These argumentations are always based on the cost of the actual birth itself, without looking at the price tag of the consequences when things go wrong.
How much would a NICU stay such as this one cost? How much will the physical therapy, speech therapy, special education and lifelong assisted living for a brain-damaged child cost? How much does an insurance company have to shell out after some years have gone by for treating fecal and/or urinary incontinence or prolapses in these women with their marathon labours and untreated perineal tears?
And, most importantly, how many natural hospital deliveries, forceps/vacuum deliveries or cesareans would that money have bought?
In the end, the money for this entirely preventable idiocy is coming out of everyone`s pocket in the form of inflated insurance premiums.
I’m not sure of a lot of hospital costs. The immediate care in a NICU is incredibly expensive. Several hundred thousand dollars over a single admission is not impossible. But the invisible costs (that people don’t think of until much later) are actually higher and occur after you leave the NICU: outpatient visits, specialist visits, diagnostic testing, therapy (physical, speech, occupational), medications, ER visits, re-hospitalization, surgeries. Chronic medical conditions are very expensive.
I took care of an HIE-damaged child for months. Add to the above costs: round-the-clock in-home nurses, ventilator, back-up vent, all tubing with backups, suction machine, back-up suction, batteries (big expensive ones, like car batteries), pump for tube feeds, cough assist machine, hospital-style bed, stander, wheelchair, PT, OT, RT, neurologists, pulmonologists, GI, primary care MD, and boxes and boxes of supplies to keep the child healthy & alive.
And i have yet to meet a family with a medically fragile child whose lives aren’t completely taken over by the enormous needs of the child. Social contacts thin out and may be entirely lost. Money is usually incredibly tight. Getting out of the house with the child is a huge production, and not everyone has the energy to do it. The insurance company almost never wants to pay for everything and so families are often in very frequent contact with them.
Just one child with severe HIE skews the entire cost-benefit calculation of home birth.
One of the things that troubles me is the chorus of “so glad he/she is fine now.” Brain damage, like autism, is a wide spectrum, and “fine” can not so readily be assumed. I don’t know, but I suspect that the degree of severity that you describe here is not as common as the children where problems show up much later – when nobody is much inclined to relate them to the circumstances of the birth.
Yep. My preemie daughter’s NICU bill was $120,000 and she currently receives $1,000 a month of speech, developmental, and occupational therapy. At 3 she will be enrolled in my local school system’s special education preschool program at a cost of something like $10,000 a year per student. She will also be eligible for my state’s $6,000 a year special needs child tax credit until she turns 18. Pregnancy and birth gone wrong is expensive.
And even without tragically permanent consequences, even in the case of a simple hospital transfer where baby and mother turn out fine, the family is still stuck paying the midwife’s bill in addition to the hospital bill. Midwives tend not to give refunds if a transport turns out to be required.
And so many homebirth midwives want payment in full BEFORE the due date. So the parents are out that cost, plus the $800-$1000 fee the midwife charges if there is a transfer (if the midwife collects fees from insurance, she will charge a fee for “emergency transfers” which insurance companies don’t cover, it’s out of pocket) PLUS if the woman wants the midwife to stay with her after she transfers to the hospital that is an additional $750 fee (the midwife will act as a doula for the woman)
What is the justification for the transfer cost again?
From what I remember it goes like this: clients are encouraged to pay the entire fee (prenatal visits and birth are all part of that) before the due date. Or at least 2/3 of it, and then the last payment will be billed after the birth. A homebirth midwife who attends someone who has to transfer (and who is not billing insurance) will charge that to make sure that she makes her full amount (and then some) even though she didn’t catch the baby. If she is billing through insurance, she will still charge the “emergency transfer” fee, but again, most insurance companies don’t have a code for a homebirth to hospital transfer and so it comes out of client’s pocket. The fee to stay with the client once her care has been transferred to the hospital is for the midwife’s support in the role as a doula. It depends on the midwife, but the standard rate here (for the midwives who give you the option, some make you sign a contract that says the midwife doesn’t have to accompany you to the hospital during a transfer) is about $750. There have been posts about this on one of the forums, accusing the local CPM practice of transferring the client to the hospital on purpose so they can charge the $1000 dollar transfer fee and not do any work. Which is kind of funny, because usually they are complaining that doctors do things like that and now they are having to admit that midwives aren’t in it just to care for women, they might like to collect those fees too.
I think the correct term from psychology is “negative suppression” but I did always have trouble keeping those terms straight.
What are those extra fees supposed to cover? If a midwife was paid in advance, what extra service is she or he providing by doing the transfer and/or by staying with the mother in the hospital? Isn’t the midwife supposed to stay with the mother until the child is born? Is the purpose of those fees to discourage hospital transfers? Maybe there’s a very real expense that the midwife has to cover that I am ignorant about. (?)
It strikes me as odd for a midwife to get paid more for a hospital birth than for a home birth.
If an individual midwife was affiliated with a hospital and had to pay fees to maintain that affiliation, then I guess one could amortize the cost of those fees across the expected number of transfers, but I suspect this isn’t it.
And transport is, or at least should be, very common. It’s like 40% for a first baby, and 10% for later babies, isn’t it? Probably higher for HBAC. I told myself that I didn’t home birth for financial reasons, but saving money was a big part of it, and if I had understood that I had about a 40% chance of having to pay both the midwife and the hospital, I probably would have reconsidered.
not to mention the helicopter!
My daughter’s hospital costs for 12 hours of life were 10 times the total cost of my elective c-section. Our family’s mental health bills since then are equivalent to one and a half elective c-sections a year, times 5 years so far. That’s not even dipping into lost work days, lowered productivity, loss of earnings and just plain misery.
All this baby may have needed was a nurse trained tin NRP and an ambu bag. Babies are born often floppy and not breathing. Given a couple to breaths in a very timely manner and they a crying. Any one who tries to do CPR on a bed has no idea what they are doing.
At a miminum, an ambu bag and someone who knows how to use it; but really, suction, warmth, and oxygen too. And then, if the ambu bag wasn’t perking him up, someone to intubate him and bag him for real. And effective chest compressions, not on a bouncy mattress. And IV access. And epinephrine. An RT, a NICU nurse, a neonatologist. Glucose, antibiotics, fluids, arterial and venous lines, chest x-rays, dopamine, serial blood gases.
In other words, a hospital.
OB RN, I have occasionally followed this same thought process when I deliver a baby, pale and floppy, and our Labour and Delivery nurses instantly spring into action, resulting in a baby that screaming and pink by the 3-5 minute mark. What happens to those babies “in the wild” when there is no (truly) skilled person to resuscitate? How much damage do these babies sustain? Maybe the labour was a little taxing at the end, but I wonder how much of the problem is due to inadequate post-partum care stacked after negligent intra-partum care.
Coming from a woman who has had TWO cesareans for fetal distress and the sister of a brother who has several severe learning disabilities probably because of prolonged distress(he’s 26 and still can’t write properly), I have to be honest that these story disgust me. I have no patience for women who don’t get the gravity of the words brain damage.
I’m literally nauseated right now so I’m going to stop reading about these stories before I vomit.
This person has her child’s whole life to come to terms with the gravity of brain damage. She’s obviously only beginning to process what happened, and it sounds pretty traumatic.
I swear. The other day I saw a report that a baby had died of whooping cough in Seattle, and thought to myself, “There’s an anti-vaxxer out there going, ‘At least he/she didn’t get autism!'”
http://www.mlive.com/health/index.ssf/2012/07/after_losing_their_baby_to_who.html
and
http://shotbyshot.org/pertussis/bradys-story/
The latter was local to me.
Is it weird that they (according to the mom) waited eight days to start antibiotics? I realize we don’t want to be loading kids up with AB’s for no good reason, but “unknown infection in the pediatric ICU” seems like a good reason to me?
Yeah, that seems odd to me, too. In my experience with a sick four month old, they don’t wait to confirm infection before bringing out the big gun antibiotics with a sick baby.
Hey immunised babies die in hospital to you know
Nice doctor tries to soften blow to parental irresponsibility by not saying “its entirely your fault that your baby is in the state he is in” Check
I had that same thought.
I know that I always do this. I`m not a NICU doc but I do treat acutely ill patients. Whenever someone dies who had a resuscitation attempt by his/her family, I tell them that they did a great job and they couldn`t have changed the outcome. That is not because those words are always true, but because I want to spare them the lifelong guilt and self-torture that would ensue from me saying they could have done something differently.
I can imagine that a NICU doc would want do do the same.
The difference is, when a family attempts to resuscitate someone who goes down in the community, we KNOW that even with perfect CPR, their odds are not good. Not that I think it’s necessarily appropriate to kick people when they’re down, but at SOME point, someone needs to say, “I’m very sorry to have to tell you this, but if you had your baby in a hospital, yes, the outcome would have very likely been different.” I watched an infectious disease doctor tell a woman that it was not her fault her baby was in the NICU with GBS meningitis after being born at home and refusing GBS screening after being found positive in prior pregnancies. Of COURSE that wasn’t the time to lay it all out, but to skirt to the question or give a vague answer would have been far more appropriate than removing her of all guilt- she’ll probably never ask again AND tell everyone “I was told by an expert that this didn’t happen because of our home birth.” If she were eventually told the truth, maybe she would save another baby’s life by sharing her own story.
That`s the big dilemma. Doctors have the mutually exclusive goals of not kicking a distraught mother while she`s down vs spreading correct information in the community. That information being that these homebirth disasters ARE entirely avoidable and caused directly by the parents` birthing choices.
When sitting in the NICU`s `grief room`opposite a crying couple who are obviously going through the worst moments of their entire lives, that first goal wins every time.
I`m not sure when the conversation about the damage to the child being avoidable should take place. It`s very likely to alienate the parents from whoever is the messenger, or even from the entire team. It`s highly debatable if this is ever in the baby`s best interest. Should it be done a week into the NICU stay? At discharge? At a follow-up appointment?
Telling the parents `the truth` is not as obvious as it sounds.
Maybe we should leave it to the nurses? Or possibly dentists? I am routinely scolded by both.
HINT: floss
Dentists will not scold you if you floss. I’m not sure that you even need to brush, as long as you floss, they love you.
BETTER HINT: you just have to TELL them you floss. I have learned through careful single-blind experimentation that my stated flossing behavior is more strongly correlated with the dentist’s reaction than my actual flossing behavior.
I agree, it’s a dilemma.
The physician has the immediate goal of securing the well-being of the patient, which includes her psychologicaI health, so I think the better part of valor is not to bring it up unless the patient asks. In which case, the doc has to tell the truth as best she can–gently.
The time to discuss it is probably if/when the patient is being counselled on future pregnancies, but of course, the person doing the counselling my not be aware of the circumstances surrounding the loss.
In any event, I’m not surprised to see “the doctor said it had nothing to do with homebirth” in these stories. It really gives the lie to the “mean doctor” mythology.
I can guarantee that parents cling to those words “It would have happened in hospital, too” like a liferaft that buoys them against anything untoward that anyone medical says ever afterward. A horrible situation, but I think that until physicians own it, nothing will change. There is no question when some is drinking then drives, then kills someone, that if they didn’t drink and drive, this probably wouldn’t have happened. We don’t soften that blow much. So how to honestly provide information without traumatizing or alienating a grieving couple? I think better to not say anything than to say “It could have happened in hospital, too” when you known darn well it almost certainly couldn’t have.
When I was pregnant in 2006, I went on Babycenter a lot, and there was a woman who had a homebirth and her daughter died. I can’t remember for sure, but I think the cord was wrapped around the baby’s neck- once again, I might be totally wrong about that. The woman said that her doctor told her that she probably would have died at the hospital, too (babies do die in hospitals, you know!).
I can’t remember her name anymore, but I looked her up about a year ago when I started reading this blog and found that the woman had gone on to have another homebirth. Luckily, this baby was safe, but I remember thinking, what if the doctor had told her that homebirth isn’t safe? Maybe her baby would have died at the hospital, I don’t know, but why allow her to keep thinking that she could try again with another baby?
I am seeing a mom and 3-month-old baby for lactation support, and the baby has dropped two percentile lines on the growth curve. I told her she should not blame herself, because she has never done this before and she relied on her HCPs to give her good guidance. She thought she was doing what was right. I’m not going to mince words that the baby should have gotten formula as soon as he lost 10% of his birth weight, but I dont blame her, I blame her HCPs. Same with moms who are tricked into homebirth.
Although…10% of normal children will cross two centile lines in their first year.
For example the macrosomic baby of a 5’4 father and a 5’1 mother with GDM might start on the 90th centile, but eventually genetics will take over from his mother’s pancreas and he’ll end up nearer to the bottom of the centiles. So for that child crossing centiles would be course correcting, not failing to thrive.
Who knows what the doc actually said? These people hear what they want to hear.
72 hours of hypothermia, and only “slight” damage on the MRI?
It seems this baby went without oxygen for at least 15 minutes. Can you imagine that?
I looked up the hypothermia treatment, and it seems that the original “insult” starts a process that LEADS to brain cell death over a period of time, in a kind of chain reaction. Lowering the body temperature in this way can slow it down or halt it. It does seem to be quite successful – but as far as I know, identifying brain damage immediately after birth is pretty difficult. Makes you wonder about those babies tucked up in the family bed with naive parents.
I tell people all the time that you cannot diagnose a concussion with a CT or an MRI. It’s a clinical diagnosis. One of the worst concussions I ever saw had stone cold normal imaging. And six months later she still couldn’t function.
Thank you Gene!! I wish my doctors understood this. I have had three concussions, and it took four months to recover after the last one. My neurologist kept saying that I was fine, that my tests were normal, but I was still having problems that hadn’t started until I had the concussion. I hit my head in October of last year, and it was only around February that the symptoms stopped completely. It was very frustrating, especially since she kept telling me I was fine when I wasn’t!
In the woman’s post, she says the doctor told her he doesn’t recommend home birth because resuscitation equipment is not immediately available.
ignoring risk factors check
midwife refusing to recognize the change from low risk to high risk check checl
How often have we heard midwives continuing to claim the pregnancy is low risk even when its clearly not . If you go overdue in a low risk pregnancy you aint low risk no more doesn’t matter how nice your midwife is.
“My client is innocent of medical malpractice, your honor, because she brought joy to the process and cheered on the plaintiff throughout her pregnancy. Besides, the MRI shows only *slight brain damage in the motor sensory area of the brain.”
Is it medical malpractice if someone with no medical training fails to perform medicine?
If I recall correctly, it is not. If a lawsuit against a midwife acutally made it to court (doubtful becuase they don’t carry insurance, so a lawsuit isn’t worth it), then the judge would consider the midwife’s actions against the standard of care for other CPMs, not CNMs or OBs. So how well did this CNM trust birth, burn incense, nap, and chat “trust birth!”
How tragic.
If you look at the Birth Stories board on The Bump, right below this woman’s tragic story is another post: C-Section Birth story. The mom links to her blog with that story: http://www.mylifeoftravelsandadventures.com/2013/04/reids-birth-story-15-months-later.html
What a contrast. Any mom considering a home birth should be asking herself which of those two stories she’d rather be writing.
That’s such a lovely babe – all chubs and pink and screaming! – out of a story that had some disaster potential. This is what modern maternity care is supposed to look like. We’re supposed to be able to be cautious and sensible, supposed to be able to get things checked out (even if we feel like we’re maybe being silly). Most of all, we’re supposed to get the happy ending this family got. At the end of it all, we’re supposed to go home with healthy babies.
Just today I had a query from a husband here in Israel whose wife is expecting. He wanted to know which hospital had “the lowest C/S rate”. This obviously is immensely important to him. I wrote back that his question was not correct: that he must have meant “the best maternal and perinatal morbidity and mortality statistics” and that he didn’t want the “lowest” C/S rate in general but the lowest rate of C/Ss done for non-medically indicated or inappropriate reasons. I’m not sure he appreciated the difference.
I don’t know how this became a metric. I couldn’t tell you my doctor or hospital’s c-section rate, and I don’t care. The babies come out when they come out. A friend was delivered (via c section) by a specialist whose c-section rate is probably very nearly 100%, because he specializes in high risk pregnancies, but I’m sure she’s very glad she chose him to handle her high risk pregnancy!
The inability to understand this baffles me. The hospital I’ll be delivering at has an ~18% c-section rate. It’s not because they go to any great lengths to reduce c-sections, or because it’s a better place to deliver than the larger hospitals a couple of hours away in Spokane. It’s because they ship a huge portion of the cases that will end up needing c-sections to those large hospitals. And rightfully so because they don’t have the resources to deal with those cases. But that doesn’t make the local hospital a better place to deliver! In fact if I had the choice, from an insurance perspective, I’d be delivering in Spokane in a heartbeat because I’d prefer to have a NICU available on site, rather than a life-flight away.
Interesting. Do you know why Pullman Regional Hospital has a 37% c section rate, one of the highest in the state, even though it’s also a small community hospital that ships the high risk stuff up to Spokane? I think there must be other factors at play than just how many high risk patients a hospital has since these two hospitals sound very similar and yet have drastically different rates? Does your hospital allow VBACs? That could explain the difference there since Pullman doesn’t.
There was a doc who explained some of this on a previous thread. Maybe someone with more searching skills and patience can find it.
The gist of it, was that in a hospital with lower resources, you have to call possible emergencies earlier. If it’s going to take 30 minutes to assemble an OR team, and you have a situation that could go south in 40 minutes, you go ahead and call it instead of letting the team go home and having to call them back (possibly in not enough time).
That might have been me. A large teaching hospital has in house staff ready for just about anything at a moment’s notice. Though even a “level one trauma” gives the trauma surgeon 15 min to get his/her butt to the ER. Lots of smaller community hospitals have doctors taking “home call” and must be available within 30 minutes. Imagine a baby in distress and the anesthesiologist is 30min away. And so is the pediatrician. That’s why lots of smaller hospitals will not do a VBAC: no in house anesthesia.
I think it was, thanks! I found it very instructive at the time, and hope I paraphrased you reasonably accurately.
Oh, wait, nevermind about the VBACs. Pullman just recently banned VBACs, but the c-section stat I was using was from 2009, when they were still allowed. And actually, I just checked the rate at Pullman is higher than the rate at the two major hospitals in Spokane!
Sorry I didn’t respond to this. I had a baby!
I’m not sure what would be driving the difference. It can’t be the OB’s as they are the same at the two hospitals, though the family practice groups serving them are different.
Two things I can think of:
1) The number I quoted is primary c-sections, not all c-sections. I’ve double checked it and it seems to be correct (~18-20%). The overall c-section rate is higher, but still only ~30%.
2) Where are you getting the number for the Pullman hospital? The numbers for c-sections for Whitman County as a whole don’t seem to suggest a particularly high rate for PRH.
Sad. I just don’t get why we aren’t more honest about the realities of birth as a risky activity – we educate on the realities of driving, or riding a bike and generally speaking we undertake steps to mitigate those risks. Most elect to wear a helmet when cycling, to look both ways before they cross a street, to wear a seat belt, to avoid driving after drinking…. The risk perception of birth and the need to mitigate those risks seems really off within the community that selects home birth.
So sad for this mother….and even more sad about her child.
I could not convince one of my teens to wear a bike helmet, because he informed me that he was not going to get into an accident so he didn’t need one. The tone he took with me (as if he was talking to a total moron) sounds startlingly familiar, just like the people who insist that their high-risk home birth will be safe. Why didn’t I just understand that he didn’t need a bike helmet? (Why don’t we just understand that THEIR birth is going to be complication free and not need medical attention?)
I expect this kind of thinking in a teenager. It’s normal. I continue to be surprised when I run into it in adults.
Why is this kind of thinking so prevalent now, even among adults? Is it that people just do not personally know enough people who have been impacted by the risk materializing?
Perhaps because I know brain injured people, one of whom was brain injured at birth and another in a car accident – I’m acquainted with why you do not want to take that risk. Maybe there needs to be more work done to help young people understand the risks involved and the reality of having such a risk materialize. Maybe birth education courses need to do more to raise awareness of risk, instead of doing their utmost to refuse the very existence of the risks that exist.
Do internet cheerleaders play a part?
Nowadays, people can find support for their craziness on the internet.
It really doesn’t matter what your craziness is. Homebirth? Freebirth? Antivax? Raw foodism? Religious fundamentalist? Atheist fundamentalist? Believe that you are a mythical creature from a video game who was unfortunately born into a human body? You will find a home online.
it’s not just that you can find others like you. it’s that it CONCENTRATES the crazy and turns into a contest to see who is the most hardcore- so maybe you are a reasonable person who is afraid of needles and would like to avoid an epidural, so you google unmedicated childbirth, and you find a message board, and before you know it, you’re delivering your baby while swinging from a trapeze over a bed of knives because you trust birth that much and everyone else is a big fat poser.
That’s why I included “cheerleading.” You can almost hear it…
“I would that, but I am not keen on the possible brain damage that could occur.”
“Bah, the chance of getting brain damage is pretty small, especially if you take the magic anti-brain damage pills and repeat the chant properly. Besides, I knew someone who got brain damage from it, and it didn’t bother them much. It’s not like they are autistic or anything.”
What in god’s name is an atheist fundamentalist?
The current generation (20-something and younger) in the US is infected with a particularly virulent strain of a lack of belief in an objective reality, that anything goes, that it is more rude to criticize than to do the rude behavior that is being criticized, that there are no and should be no objective standards because who are we to judge? That judging in and of itself is morally wrong. That we should live and let live (and shut up) in pretty much every single situation.
Am I overstating it? Is it worse in the middle and/or upper classes, perhaps?
I agree, but I don’t think it’s just 20-somethings and younger. Actually, I would be really interested to see if there has been any research identifying specific trends in that attitude.
For sure. If you are going direction, there is actually a line of demarcation that occurs about about age 55: the baby boomers.
I say it half in jest, but half serious: the baby boomers are responsible for a lot the trends of our recent history, including
hippies in the 60s
disco in the 70s
yuppies in the 80s
country line dancing (aka more disco) in the 90s
Now you are seeing the effect of baby boomers’ kids, having been raised by baby boomers.
Of course, it’s not all bad. Baby boomers and especially their kids will bring us marriage equality.
Ah, the young people today [handwring, handwringing]!
Has there ever been a time in history in which the old farts didn’t say that the young people were worse than ever before?
No. It’s always the “worst it’s ever been.” This doesn’t mean there are no cultural changes that are problematic.But there isn’t hand-wringing in my post or any of the replies I’ve seen so far.
Probably not. Anymore than there was a time when the young didn’t believe they knew everything so much better than their elders.
As an old fart, I find many of the young quite impressive, but some of their certainties tiresome.
I work with 20-somethings on a daily basis, and have not noticed this. Unless you simply mean the naivety of youth, in which all of life of groovy.
I’m not old enough to have been a hippy in the 60s or 70s, so I may not have enough perspective, but I have noticed cultural shifts over the decades, an increasing sense of moral relativism. Part of this is clearly the naivety of youth, but it is also more than that.
Youth has always been rebellious, which is the nature of the beast, so that is not what I mean. Nor am I talking about a “moral decay” or anything so melodramatic. I agree with The Bofa on the Sofa and theNormalDistribution … it’s not just 20-something and younger, it’s part of a multigenerational cultural change. And of course, as with any cultural change, this does not mean that every single person partakes, nor is it so simple as “all good” or “all bad,” nor does it mean we’re going to Hell in a handbasket.
But this is part of why so many people react like Dr Amy and we commenters are being *mean* by pointing out facts, or by criticizing. Because, well, how dare we interrupt their pretty illusion! There’s an actual sense from those folks that we are wrong to do so.
That’s not because they are Millenials. That’s because they are immature.
I’m reminded of the many many times I said something blunt or unpleasant (but true), and my mother-in-law responded with “That’s not nice!”
My reply is always “It’s not mean, either.”
Give a concrete example. Because I work with teens and 20s every day, and I do see a few differences, but I wonder what you see. I think that today’s teens and 20s are much more tolerant of sexual and gender difference. Kids who “seemed gay” got bullied mercilessly when I was in highschool. Not a single one was able to come out ever due to that. It literally would have been dangerous. Todays teens and 20s do a lot less sexual tsk-tsk-ing. On the other hand they seem *more* judgemental of smoking cigarettes, way more judgemental of drunk driving, and way way more likely to wear seatbelts. Back when I was in highschool it was almost the norm to drink and drive. Kids today also seem more comfortable with kids with disabilities. It’s not perfect by any means but I think there is less bullying and hazing than there used to be.
As you and Bofa point out, that is a great positive about today’s youth: The prejudice of earlier generations is reduced quite a bit. This is true in many areas (less racism, less sexism) but almost nowhere is more improved than treatment of LGBT, as you say. To my kids, their gay friends are mostly out of the closet and are seen as “kids who happen to be gay.” Not that it’s a paradise. Prejudice still exists, but it is much improved from my childhood. When I was in college (mid-80s), several friends came out to me and it was nervous torture for them to do so and such a profound relief to them when I shrugged and said, “OK.”
This lack of judging is the good side of these changes.
My oldest tells me that there are no good words or bad words, just words. While, while partly true, the way she puts it ignores the importance of context.
She sees no problem at all with a 14yo dating a 20yo. To her it’s perfectly normal, perfectly fine. When I was in high school and a 15-16 yo peer started telling me her life story and started talking about her 25 yo boyfriend was nicer than her previous 35yo boyfriend (or was it the other way around, I forget), I found the concept revolting. My daughter thinks if two people are OK with it, no-one else has the right to judge, even if they are 15 and 25.
The US is not a monoculture. But looking at kids’ TV programming, the disrespect shown to parents on TV, the number of kids who lie to their parents on TV is a lot higher than it was when I was a kid.
And I do believe that a lot of this ties in with the people that inevitably swoop in here and call us mean for pointing out facts or for being critical. It’s not that in the past, those who disagreed would say, “Oh, you’re right. I didn’t think about it that way.” We would have been seen as “the establishment,” perhaps, in the 60s. But IMHO, for a large number of people, the reasoning (or in some cases lack thereof) behind rejecting what Dr Amy and we commenters say is different today than it would have been decades ago.
I’m not sure how much your daughter’s lack of concern for a 14 year old dating a 20 year old (or 15-16 with 25 or 35) has to do with our culture having become more accepting of differences as it does with her lack of maturity. The concept of a very young person dating an established adult isn’t unsavory because of some arbitrary cultural norm… It’s because there is an imbalance of power between a young person and someone who is older and has more experience in the world. It’s the same reason we disapprove relationships between superiors and their employees, teachers and students, doctors and patients, etc. It’s not always a bad thing, but there is clear potential for abuse and so it’s frowned upon.
I can actually see what Eddie is talking about.
It is like giving a judgment is wrong, because there is no standard set of good and bad. Not on EVERYTHING. Say, driving drunk is stupid, and you can say it, and nobody will tell you it is not true.
But try saying that vitamins have no proven good effect, and people will tell you that everybody has a different idea and you shouldn’t really judge X because she gobbles vitamins or supplements by the hour.
That’s a good example of what I was trying to explain, and of the distinction. Looking back on what I wrote yesterday, it comes across like an indictment of the millennials, which was not my intent. I was more trying to get to this cultural change.
One of my sons told me one day that gay people chose to be that way. When I started to disagree with him, he got angry with me “because his opinion was just as valid as mine.” At that point I sharply shared the experience of gay friends of mine from college, and how strongly they tried to NOT be gay to avoid the prejudice, external judgement, and internal judgement. One friend of mine joined the clergy because he couldn’t be straight but he could be asexual.
Immature people have always had some reason to reject facts that are inconvenient or uncomfortable. But the actual reason used, or the reasoning used, changes with culture and the times.
Don’t forget that in Hollywood movies, the hero never dies. And we all feel that we are the heroes in the narrative we inhabit.
It is definitely worse n the middle/upper classes. I live in a poor and working class neighborhood with many new immigrants, and never run into this attitude. If I go to the other side of town, it’s everywhere.
Not entirely off topic: I have spent the last 5 days at our place in Oregon. Someone at the Starbucks was raving about Sherry Dress, CPM. Apparently Sherry was “so calm” and “so experienced” (since she has been a homebirth midwife since 1975 in a town that just now is reaching a population of 13,000) that she delivered a FOOTLING BREECH AT HOME. Cause, you know, she is the bestest bestest midwife ever. And apparently is the BFF you wanna have bringing your angel earthside. The woman whose baby she caught said NOTHING about her baby, was only talking about her midwife.
I would have had such a hard time keeping my mouth shut overhearing that story.
For the sake of my blood pressure and the fact that it’s the only Starbucks for miles, I kept my mouth shut. I wanted to scream. Midwives like that are the EXACT reason that Dr Amy has this blog. Not to “spew vitriol”. Not to “hatemonger”, “be hateful”, “spew poison”, “hate midwives”-whatever the trolls will call it. I had heard about this midwife before, but not that she had delivered a footling breech at home. The hospital in La Grande is small, there are only two birthing suites and yes, there are no CNMs available in the town. But there are at least 7 OBs, and in a town of 13,000 that should be enough options if you don’t click with your first care provider. Not that any of them would deliver a footling breech at home, but if you went to all 7 of them for a second opinion, surely one of them would be able to reason with you about why it wouldn’t be a good idea.
It’s terrifying enough when someone attempts a footling breech in a city like, say, Eugene, where a high level NICU is a few miles away. But La Grande is so remote (I grew up about 70 miles from there). If something goes wrong, it would be absolutely catastrophic.
I found out that most people have their scheduled surgeries at St. Luke’s in Boise, they also go there for appointments with specialists. La Grande is indeed remote!
Funny that you think it’s too far to get another Latte when we are discussing how far away is safe to be from help in an emergency.
Caffeine withdrawal is a real emergency.
I associate the La Grande house with hard physical labor-since that is what I do there-I need strong coffee or I will not survive! I didn’t have any fight in me that morning and did feel like I would have ended up in a brawl if I opened my mouth.
Must have been surreal to be overhearing that conversation. I have been in lots of situations like that.
It was. It’s one thing to have someone come in here and replay every NCB catch phrase, it’s quite another to hear someone loudly proclaiming what a chance they took with their baby’s life while you get your caffeine fix for the day.
Perhaps it’s good that it occurred while you were still absorbing the caffeine?
Also good that I had been woken up at least 5 times in the night by the large owl that lives in the tree above my bedroom there AND that there had been a cow mooing in the pasture near the back of the house. Being groggy was a benefit
Wow, it’s like surviving Russian Roulette and then saying that the reason you survived was because you were so skilled with a gun.
The truth is that the majority of footling breeches will deliver safely even without a birth attendant present at all. Just like the majority of Russian Roullete trigger pulls will end safely. Sounds great as long as “85% survival rate” is acceptable to you.
Well, the gun finally fired. Sherry Dress oversaw a birth in Walla Walla back in June 2015 that ended with a stillborn baby boy.
The EEG came back clear and the MRI showed slight brain damage in the motor sensory areas of the brain.
She clearly doesn’t know what that means. I have a genetic condition that causes problems in the motor sensory areas of the brain, and it ain’t fun, lady. I didn’t learn to walk until age 4, I couldn’t tie my shoes or write my name until the 3rd grade, and I still have a lot of problems. I can’t drive, for example, or even walk across a room without tripping or bumping into something.
But, hey, no big, you didn’t have to have a nasty induction or CS, so it’s all good!
This is so heartbreaking…that poor little boy.
Just read in the news today that pediatricians are now recommending that a person dedicated to the medical care of the newborn should be present at any homebirth:
http://health.usnews.com/health-news/news/articles/2013/04/29/pediatrician-group-issues-home-birth-policy-statement
Perhaps if their suggested policy becomes standard practice, it would reduce the number of tragedies like this one.
almost all the comments on that article are ridiculous.
Of course, it would also help by jacking up the price a lot, too. Fewer people will do it as a money saving adventure.
I’m so tired of people trotting out that study in BC as evidence that homebirth is safe. Quoting from the article:
“But Watterberg said a study done in British Columbia, where there’s a more integrated system that supports mothers birthing at home, found no increased risk of neonatal death.”
You know, the study that was UNDERPOWERED to detect mortality? The study with a nonsignificant trend towards increased NICU admissions and ventilatory support for homebirthed neonates? the study planned and executed by a group that is biased towards intervention free childbirth and homebirth? That study? Really? Who knows what they would have found if they’d included a few hundred more women.
Yep. That study. It calls for a blog post about why it’s such a “quality” piece of work….you up for it?
I read the article and I was initially annoyed at the AAP. But then I read their policy and it’s really quite reasonable. If I understand correctly they aren’t endorsing homebirth, but IF you must, have a CNM or AMCB CM ( which is a CNM equivalent right?) and someone who can do a FULL resuscitation. I just recertificied my NRP and I wonder if now they also mean having, oxygen blender, oxygen saturation monitor, intubation skills and tools, ability to place an umbilical line and tools, epinephrine, volume expander? The policy is quite reasonable. But the press and public are going to take this as an endorsment of CPMs and it’s not.
So, here’s the choice, Moms. You can either choose to labor at home and have a much higher chance of being that heartbroken woman outside the NICU for weeks praying desperately that medical technology and a team of specialists will keep your baby alive and as minimally brain damaged as possible, or you can have a higher chance of having a 4 inch scar somewhere nobody will never see.
You can have the higher risk of being the woman who has a not so rosy memories about her forceps delivery / c-section / pitocin or you can run the higher risk of being the woman who, when asked how many children she has says, “I have 2 living children.”
Like my online friend Tara said:
Mom avoided the interventions, too bad her baby did not.
What exactly does damage to the motor sensory areas mean? Trouble with voluntary movement? Trouble preventing involuntary movements? Sensory processing disorders? Any or none of the above?
For this baby, who knows? The baby was born March 15 according to her profile. It’s just too early to tell.
I just meant what are the possibilities? It’s been a long time since I learned my parts-of-the-brain.
It means it’s anyone’s guess, really. The freezing technique does seem to be pretty good at reducing the swelling/bleeding which compounds the original “insult” to the brain. Most likely is CP – but a very wide range of types and severity means that doesn’t tell you much either. One doctor who had seen my daughter’s brain images but not my daughter stated very confidently that she had spastic diplegia – but she doesn’t. Like birth, it is a lottery, as you can lose some and still function, so this child may grow up to show minimal consequences, or many. A brain damaged child at two may or may not be noticeably different from any other child, but the gap can widen as more complex skills are acquired.
The induced hypothermia protocol is successful in reducing brain damage and death in babies with moderate and severe HIE. I have seen it make a tremendous difference in outcome in our NICU
These stories are just so sad and so similar. I hope her child ends up being okay, but wow. All that could have been prevented by being at the hospital in the first place.
The comments….good grief. “I’m sorry you didn’t get the birth you wanted, but I’m so happy to hear that your LO is alright.” I think what she means is, “I’m sorry your son has brain damage, but I’m glad you got the birth you wanted.”
Apparently brain damage doesn’t mean the same thing to these people as it does to me. If seeing an obstetrician prevents me from ever having to talk to a pediatric neurologist, sign me up!
I’d let them cut me in HALF if it protected my baby’s brain. And every time I saw that big scar bisecting my body, I’d think, “That’s my girl, right there.”
I agree wholeheartedly.
Absolutely! You made me tear up! I hate my csection scar! They had to cut me open more, crudely, when he got stuck as they tried to pull my baby out. It’s crooked, jagged, purple and raised on the one end and that end comes above underwear and swimsuits. However, everytime I look at it I do think that’s the scar I have for my precious son! It was worth it!
I concur…. the comments are grotesque…. these people need a serious re-alignment of their priorities. “Congrats!” Huh?
“Congrats” is the default reaction to any birth story on a mommy board. This isn’t a home birth advocacy board or debate board, it’s just where new moms share their birth stories with each other. No new mom is going to tell another new mom after a traumatic birth, “You made a bad choice and your baby got hurt, so you should not be happy about his life.”
I couldn’t resist posting a comment in response to her story….
For the love of God.
When is this country finally going to catch up with the rest of the world and make it illegal for these IDIOTS who aren’t qualified to to deliver UPS packages, let alone a human being, to attend these births?? When?? How many babies have to suffer and die??
Please do not be critical of UPS drivers. Even before you apply for a driver position you need to first have a commercial driver’s license (which requires they pass a specific federal test), clean driving record, pass a drug test and a physical examination by a medical doctor (not a chiropractor or holistic healer). How many midwives can do that?
Exactly the point!
And UPS drivers recognize that a late or broken package is not a variation of normal.
I hope this baby gets the best possible outcome under these circumstances.
I am not surprised by the paeans these mothers sing to their midwives. I imagine it would be so, so hard to face the truth that it was their choice who led to their babies’ damage – and the midwives were part of that choice. Not everyone has the courage of Bambi, Liz, Margarita, Wren’s parents, and Erin Newman-Long, among others, to confront that truth. Especially in the beginning.
And now let’s hold our breath, fellow terrible people. I give it a day before a concerned (internet) friend barrels down here to tell us just how terrible and unsupportive we are being.
It took me YEARS to face the truth… that my horrible decision to have a homebirth resulted in my son’s birth injury. Around age 3-4 years old is when I finally faced the facts about my son. And wow… did it suck. Before that time, I was so happy with my midwife for saving his life (and yes, I am thankful she was able to)… “it would have happened in the hospital” (NOT), “she did everything right” (NOT) and many other lies. Much easier to live in denial. And someday I will have to ask my son for forgiveness and tell him the truth… that my decision led to his inability to use his arm correctly, that I’m the reason he has pain, and that while the midwife who delivered me missed a trillion red flags about his impending shoulder dystocia, ultimately, it was I who hired her and put his life in danger.
I am trying to think of something to say and I can’t come up with anything. I am so sorry for what you and your family have faced and will be facing in the future.
The problem is that the only people taking responsibility for bad homebirth outcomes are the parents – not the HB midwives, not MANA, not the morons on MDC, not Rikki Lake, nor the state legislatures that continue to license CPMs. I stand by my assertion that the vast majority of women would choose to give birth in a hospital if they could not find a midwife willing to deliver high risk patients at home. What is particularly infuriating about the situation is that BY DEFINITION, homebirth midwives should ONLY be attending to women with no risk factors, yet again and again we read about midwives who refuse to transfer women out of their care when red flags develop. Mom has a breech baby? No problem – breech is just a variation of normal! Mom is 42 weeks? No problem – babies know when to be born! Baby doesn’t survive the birth or is severely injured in the process? Some babies just aren’t meant to live. And yet there are virtually no consequences for midwives that operate out of scope and kill and maim babies and their mothers! When you hire a healthcare provider, you do so because you accept that you do not have the expertise to detect when something goes wrong. The onus should NOT be on the parents to determine whether or not their midwife is capable – MANA and the state licensing boards are supposed to ensure competence. They don’t, and then the families are blamed for not doing their research. WHY IS THIS ACCEPTABLE?! I WANT YOU TO EXPLAIN THIS TO ME, MISSY CHENEY!
One of the most ridiculous refrains, to me, is the chant, ”My midwife can’t attend me at the birth center but we’ll do it at home! See? No problems!” Hello? If something is considered too high-risk for a birth center, the provider shouldn’t try to handle it at home. Hell, they shouldn’t even offer it as an option. But I suppose I’m just sheeple this way.
Don’t hold your breath for Missy Cheyney offering explanations. It’s all the parents’responsibility, don’t you know? Funny how it’s never the poor C-section victim responsibility. But with homebirth – oh, it’s different.
I am all for the parents taking responsibility for their decision for hiring this or that midwife. And that’s it. What follows is the hired midwife’s responsibility to provide as safe birth as possible. It’s astounding how mothers are blamed for… what? Not picking the foetal distress with their inner feeling? Not resolving the shoulder dystocia with their own two hands?
Oh, I don’t expect Missy Cheyney to actually reply, but I’m pretty sure that she reads this blog. She needs to be reminded every single day that she and her cronies at MANA have blood on their hands.
Missy Cheyney: Why is Brenda Holcombe still practicing as a CPM? Her license was taken away and she still catches babies in La Grande Oregon. The baby she harmed had an Apgar of less than 7 at 10 minutes.
This is such an important thing to say. What good does it do to restrict midwives to low-risk cases when they blatantly deny high-risk situations?
It’s not that they can’t recognize them, they just refuse to admit that they are high risk.
As long as that practice continues, they need to be stopped. Completely. When they come to their senses, then we can think about situations that might be appropriate.
A comment on this article suggests that we shouldn’t claim HB is safe, not because it isn’t safe, but because it places too much burden on the midwife. To be, you know, safe. http://www.mothering.com/community/a/untrue-assumptions-about-homebirth
YES! This is a quote from a CPM’s website about who is responsible (in her mind) “I also believe that the parents are ultimately responsible for their own health care which will affect the outcome of the birth. This responsibility is to educate yourselves concerning all aspects of pregnancy, birth and parenting. I will assist with information on nutrition, exercise and childbirth education , but you must assume responsibility of maintaining your own excellent health care. I offer for your use several books and videos on these subjects, some of which are required reading and viewing during your prenatal care. Homebirth couples must take extra responsibility in these areas since medical back-up is not readily available as it is for those birthing in the hospital” So yeah, she will catch the baby but the PARENTS are responsible for any bad outcome, probably because they didn’t do prenatal yoga or didn’t eat enough kale
I have news for that midwife.
It is perfectly possible to have an unproblematic birth and a healthy baby even if you sat on your arse and ate nothing but burgers and fries for the entire pregnancy.
How come we are sheeple if we listen to our doctors, but it is ok for a MW to have “Required reading”, which apparently cannot be questioned?
OH lordie. I sadly ate a LOT of burgers and fries (and NO KALE WHATSOEVER) while pregnant. I had a particular penchant for “Five Guys” brand burgers.
And fruit. Once I consumed a whole bushel of peaches before it went rotten.
My OB gave me the side eye, checked my blood pressure and sugars, and told me to stick in a salad from time to time.
“This responsibility is to educate yourselves concerning all aspects of pregnancy, birth and parenting”
So why spend money on her? Once you educate yourself on all that, read a couple of google articles on exercise and nutrition, and save the money for the ambulance.
It took me about 2 years, and that’s without my daughter having any permanent damage from us waiting around for hours for a baby who (retrospectively) clearly should have been in a hospital. I cannot imagine how much harder it would be if there had been any long term effects for her. It is scary enough to know how close and to see how horribly I misjudged things. I am so sorry for your pain, and grateful for your courage. *hugs*
*Every* parent at some point has to ask their child’s forgiveness for some sort physical or emotional damage. Some of us just get luckier than others.
Your son’s story would be a valuable addition to the “Hurt by Homebirth” blog.
Just read a post by an older child who had 2 younger siblings die from homebirth, and how traumatic it was for the rest of them even though they were told it was inevitable (God’s will) — and how absolutely betrayed and devastated she felt when a 3rd baby survived the same (cord around neck) because hospital birth. Brutal stuff.
If she’d gone to a CNM or OB and had induction in the hospital somewhere around 41 weeks, she’d probably have had a less comfortable labor and delivery, not felt that her care provider was her BFF–and had a baby without brain damage.
” I attribute his fast recovery to both the amazing care we received from some of the top NICU med professionals in the world ”
who did their absolute best to clean up the mess of a post dates homebirth disaster…
I know this has been brought up countless times before, but I still don’t understand the logic and disconnect. If you are so hell bent on avoiding interventions and doctors are evil/bad/unnecessary, why for heaven’s sake is the high tech world of the NICU acceptable? Interventions (cooling, tube feeding), monitoring/testing (EEG, MRI), medications (homeopathy for you, but FDA approved and rigorously tested chemicals for you baby?).
And I will say this (I don’t doubt that other medical professionals told her this as well, though maybe in a kinder more obscure way): a diagnosis of HIE with seizures and an abnormal MRI is NOT a “normal, healthy baby”.
She is in denial. Her baby, according to her profile, was born on March 15, so the reality of the brain damage can’t be known yet. It will slowly become apparent to her over the next year or two, as her baby fails to meet his milestones or develop normally.
She has a tough road ahead of her, I know from personal experience. I at least get to sleep well at night knowing that what happened to my son (a stroke after a heart surgery for his heart defect) was not because of a terrible choice that I made, she does not. And it is hard. My son is 9 and we are still discovering things that need to be worked on. It was so much easier when all I had to do was take him to PT/OT.
Because everyone who has a home birth thinks this — all the high tech interventions — won’t happen to them. They are going to have their baby in a swimming pool in their living room and never have to step foot outside.
They think the safer, less complex, less dangerous, less emergency interventions are “unnecessary”. They are the ones that second guess CS and go “probably could have done without it.” To them, no section should happen unless it’s a life threatening emergency, not to prevent what might in fact BECOME a life threatening emergency. They have a different measurement of risk than most people. More rational people say “this utterly insignificant risk of intervention, this vanishingly minor risk of C section — those are totally worth avoiding the insanely major risk of stillbirth or brain damage or NICU stays”. NCB people have the opposite POV. They only see the best case scenario.
As a very wise person once said, “The purpose of interventions is to prevent emergencies, not deal with them. If you have an emergency, it has already gone too far.”
I would especially say this holds for a “life threatening” emergency. Don’t know about you folks, I don’t want to be in a situation where my life is threatened, regardless of how good the people around me are.
My sister in law had a normal, low-risk pregnancy. Nothing about her pregnancy indicated that there might be a problem with the baby or with the birth. She chose to labor in a hospital. Thank God she did, and thank God for the “Cascade of interventions” because without a C-Section my nephew would have died in birth. See, he had a very rare birth defect that caused the top of his skull and scalp not to develop (I’m still not clear on what caused that, seven years on). Basically, the top of his head was missing, leaving his dura-mater exposed. Had she delivered him vaginally, his brain would have squeezed right out of his skull, as there was nothing to hold it in place. Instead, laboring in the hospital, the doctors picked up fetal distress on the “evil monitors” and did an emergency C-section which saved his life. After he was born he was taken to one of the best NICU’s in the country by life-flight helicopter where he spent his first three months. I call him our miracle boy because we were told that he would not survive and if he did he would be severly brain damaged. He is seven now, bright as a kid can be and very strong.
Incorrect infant CPR procedures by midwife? Check. (Baby should be on a hard surface not a bed, and 911 should be called immediately as CPR is begun, not “very shortly” after CPR is started.)
It’s hard to tell from the description, but she may also have been doing CPR on a baby that had a heartbeat. That situation (heartbeat, no breathing) calls for rescue breathing, but not CPR as there already is circulation and you don’t want to potentially send the patient into V tach by compressing their heart.
FWIW, NRP guidelines recommends positive pressure ventilation (PPV) for a heartrate under 100 and adding chest compressions for a heartrate under 60.
Oh, and the bed thing is totally accurate. I’ve had a run of parents who “did CPR” on their infants recently (none needed it) and all were done on a bed. So not only was I teaching them WHEN to do CPR, but HOW to do it properly. And these were people who had gotten CPR training…
Ah. I only do adult where you pretty much just give drug for bradycardia. So maybe the compressions were correct. Kind of hard to tell with the information given.
I don’t think she got much of an effect if it was done on a bed anyway.
We give drugs in codes for newborns as well, ET tube or umbilical vein catheter. But something tells me they didn’t have a neonatologist or respiratory therapist at home to quickly perform those procedures like they do in a hospital. Besides, those lines are so cold and impersonable.
So much for them being “trained in infant CPR”. Sounds so much like the midwives who were singing along with the parents (based on advice from Penny Simkin) to try and get the baby to take a breath. Or Rixa Freeze’s video of Inga’s birth.
Isn’t lay MW CPR blowing onto baby’s face?
Or that one midwife who put her finger into the baby’s rectum to try and get him to start breathing ((anyone remember that one, the waterbirth where the well used fishnet thing was in the frame for much of the birth?))
I took an infant CPR class when I had my son. They told us to keep a phone in the kitchen (preferably one where there was a speaker so that we could hear the 911 operator), tape the CPR directions, emergency phone numbers (poison control, etc), and our address to the inside of an upper cabinet door (lots of parents blank on their address when their kids are having a medical emergency), and lay the baby on the hard counter underneath for CPR.
The idea is that you will be able to speak to the 911 operator while performing CPR on an appropriate surface and have all the info you need available.
It’s infuriating and sad to think that a midwife can’t rise to even this most basic level of care.
I blanked on my address when I had to call 911 for my baby daughter (febrile seizure, she’s fine!). I remember sobbing to the woman on the phone “I can’t remember where I live!” Ever since then, I have our address written on the fridge in black marker.
Good idea! My daughter came home with a card to record the correct details on it from her kindy’s ‘Emergency Services’ day. I didn’t bother because she can’t read anyway, but reading these stories it reminds me to do it just for myself.
KarenJJ, I think it would be a good idea to fill out your daughter’s emergency card. It doesn’t matter if she can’t read it yet because someone else could need it to help her. It’s not just adults who can forget important information in an emergency.
Tragic
Oh, God.
I pray that those children will never learn that it is their mother’s choice that led to them being brain damaged for life. I really, honestly, pray so.
Can you image otherwise?
If she wanted an special bond with her child, she got it. She is going to be taking care of a disabled child that isn’t going to be as independent as a healthy one.