Homebirth dramatically increases the risk of a baby’s death and appears to increase the risk of a mother’s death.
When I first started blogging about homebirth deaths back in 2006, homebirth was such a rare and remarkable occurrence that I could keep track of most homebirth deaths. I wrote a post about nearly every death that I heard about.
As homebirth has become more popular, the deaths have been coming fast and furious and I can no longer keep up. If I wrote a post for every death I heard about, the blog were be dominated by deaths and the posts would have a depressing sameness: baby drops nearly dead into clueless midwife’s hands, uterus ruptures at home, massive maternal post partum hemorrhage. “Trusting birth” hasn’t lowered the incidence of these lifethreatening emergencies. “Trusting birth” has simply increased the death rate because they happen far from lifesaving experts and equipment.
“Trusting birth” to prevent a homebirth death is as effective as “trusting pregnancy” is at preventing miscarriages. “Trusting” doesn’t do a damn thing to prevent anything.
In the last few weeks I have learned about:
A baby who died at homebirth in Florida 12 weeks ago, unexpectedly born dead.
A baby who died in Texas 6 weeks ago, unexpectedly born pulseless.
A baby who died in Phoenix last week whose mother, a doula, had a previous HBAC. I have not been able to establish whether the caregiver knew that the baby was dead before birth or was not expecting it.
A baby who died in October after his mother labored at The Farm and was transferred to the hospital for failure to progress. On arrival at the hospital, fetal distress was noted and the mother had an emergency C-section. It was too late. The baby could not be resuscitated.
A mother who died in December in Texas after postpartum transfer from homebirth. The baby was born lifeless but surived after cooling therapy to mitigate brain damage from lack of oxygen at birth. The mother died despite days of heroic efforts to save her life at the hospital.
These are the deaths I could personally confirm. I have been told of others.
Five mothers who trusted birth: 4 dead babies and one dead mother.
Thinking about homebirth? This could be YOU or YOUR BABY. These women were no different from you. Their midwives were no different from yours. Your trust in birth can’t protect you just like it didn’t protect them.
Why do homebirth midwives counsel women to trust birth? It’s marketing ploy to elide the fact that you can’t trust homebirth midwives to save your baby’s life or your life; all you can do it trust (i.e. pretend) that your birth won’t develop life threatening complications. If you pretend wrong, your baby dies or you die, or both.
I have come to realize that it is going to take the death of a celebrity’s baby or her own death to wake people up to the deaths that are occurring all the time at homebirth. That will be the tipping point, in the same way the the Disneyland measles outbreak became the tipping point that definitively discredited the anti-vaccination movement. There had been outbreaks of vaccine preventable diseases before; there had been deadlier outbreaks (pertussis); but for some reason, the Disneyland outbreak gripped the public consciousness. It will take something like that for homebirth deaths to grip the public consciousness.
There is a steady stream of preventable homebirth deaths. They happen in every state, with every type of midwife. Most people, including most homebirth advocates aren’t paying any attention, partly because homebirth midwives are lying about the deaths, hiding them, refusing to discipline the midwives involved and publishing deliberately misleading papers that slice and dice the data to obscure hideous death rates.
I BEG any woman contemplating homebirth to consider:
Trusting birth is like trusting the gun at Russian roulette. Sure the odds are high that when you fire the gun, there won’t be a bullet in the chamber and you will survive, but no amount of trusting the gun changes the fact that there is a bullet in one of the chambers and it’s just simple probability whether that bullet will wind up in your head. Similarly, the odds are high that when you have a homebirth, you won’t have a life threatening complication and you and your baby will survive. But no amount of trusting birth changes the fact that life threatening complications will happen and it’s just simple probability whether they will happen to you.
Please, please, please give birth in a hospital. You might not like the experience; the chance of ending up with interventions is high; the chance of ending up with a C-section may even be higher than it should be. But the chance of ending up DEAD (you or your baby) is very, very low.
I am so weary of writing about dead babies who didn’t have to die, reading soul crushing stories of mothers who risked their babies and lost, and contemplating the anguish of small children growing up motherless.
Thinking about homebirth? Think about the fact that what happened to these women could happen to you … and trusting birth won’t do a damn thing to stop it.
Amy Teuter, MD
If you were at those births, would you have been able to prevent, the five deaths, of the people listed?
Almost certainly I would.
Any competent OB working in any first-world hospital would almost certainly have been able to prevent those deaths.
If she were at a hospital with access to the tools and technology necessary, surely.
People seem to forget, because we are so far removed from it, that childbirth was the leading cause of death in women. As a labor and delivery nurse I have seen situations that make me thank God that my patient was in the hospital. Homebirth should not be banned, but families need to know how quick a normal labor can go bad in a matter of seconds…..literally
I don’t know how homebirth COULD be “banned.”
However, you can ban things like allowing healthcare providers charge money for doing homebirth services or allowing unqualified practitioners passing themselves off as competent healthcare providers.
You can never stop women from not coming to the hospital for delivery (besides, sometimes emergencies just happen and they don’t make it). And you won’t be able to stop unscrupulous hobbyists who offer their services under the table. However, you can make it clear that the medical community does not support and will not facilitate intentional homebirth, to make it clear that those doing it under the table are not practicing within acceptable standards.
People always have the right to choose to eschew such standards, but they need to do so knowing full well that is what the are doing. That’s a far cry from the current situation where you have CPMs running around selling the claim that HB with them is just as safe or safer than the hospital.
I’m wondering if the Phoenix homebirth was with this midwife I used to know back when she was still a doula. She went off into the woo, didn’t vaccinate her kids and was deemed nutso by the group of friends I had at the time.
This is a bit off-topic, but it will draw the same groans:http://inhealth.cnn.com/cooking-with-crohns-disease/pine-nut-and-pomegranate-salad
Imagine telling patients with Crohn’ s disease, who must avoid fiber and usually are told not to eat raw veggies or fruits (except bananas), to eat RAW POMEGRANATE SEEDS! I complained to the chef on Twitter; no response. I complained to HealthGrades, and got this:
Dear Libby Cone,
Your email was received by HealthGrades.com.
Although HealthGrades profiles and provides quality reports on physicians, we do not provide medical advice or physician referrals. My best suggestion would be to speak with a current and trusted physician about your options and information.
We apologize for not being able to help more.Thank you,
Michael | Healthgrades Support Team
Healthgrades: How America Finds a Doctor™
999 18th Street | Suite 600 | Denver, CO 80202
cs@healthgrades.com
http://www.healthgrades.com | http://www.cpmhealthgrades.com |
http://www.bettermedicine.com
I think they’re going to feature diabetes recipes with the heading: “Powdered donuts: the mainstay of a healthy diabetic diet.”
Crohn’s disease, irritable bowel, it’s the same thing, right? *sarcasm*
Is there a link to the article on the baby who died at The Farm? I’m guessing it’s Gaskin’s farm? Interested in reading more about it, but had trouble googling it.
You know what, as someone who lost 1/4 of her blood after delivery and went into hypovolemic shock (which is fatal unless treated immediately), I’m going to list all the things I had in the hospital that saved my life, and that I would not have had in a home birth because US home birth midwives can’t do this.
1. Prenatal testing that found I was anemic about 4 months into the pregnancy, so they prescribed massive doses of iron (amounts you can’t get over the counter) to give me more of a margin in case I did have a post-partum hemorrhage. Most US home birth midwives can’t order such tests and/or are philosophically opposed to “invasive” tests. Also, they can’t prescribe the iron.
2. Ultrasounds every 2 weeks to check the babies (mono-di twins, who have a 1 in 8 chance of developing twin-to-twin transfusion syndrome, which is fatal but can be treated if caught early enough). Ok, this didn’t save MY life, but for 1 out of every 8 moms carrying mono-di twins, it’s what makes it even possible to save the babies.
3. Ultrasounds to check my placenta (which initially was covering the cervix, so they watched it for a while to make sure it moved).
4. When I developed some signs of preeclampsia, twice weekly blood tests for the last several weeks of my pregnancy to check for subtler but more dangerous signs of pre-e. In week 36 these blood tests showed my kidneys were failing due to pre-e and I was sent upstairs for immediate delivery. Home birth midwives could not have detected this problem and even if they’d known about it, they can’t perform inductions or c-sections.
5. Blood typing, and blood of the correct type right there in case I needed it.
6. Pitocin, administered right after delivery to help prevent post-partum hemorrhage. In my case I still hemorrhaged, but I would’ve lost even more blood–and even faster–without it. Even home birth midwives who carry Pitocin do not administer it to all women right after birth; they do so only once they notice that the woman is hemorrhaging, and that can be too late.
7. A heplock (IV port) in my arm so that if they needed to give me blood or fluids (that is, if I started hemorrhaging), they could do so immediately.
8. Continuous monitoring of my blood pressure, so that when I did start to hemorrhage they noticed immediately.
9. Dozens upon dozens of doctors on site, so when I started to hemorrhage three doctors ran in within seconds and started working on me (and there were also pediatricians and neonatologists on site in case my slightly premature newborns needed help–which, as it turned out, they did).
10. IV fluids hanging there on an IV pole in the recovery room, just in case I hemorrhaged… so when the three doctors ran in, they just grabbed the fluids line and popped it into my heplock.
And despite all this I *STILL* lost 1/4 of my blood and went into hypovolemic shock. How much more would I have lost in a homebirth? I would have left my beautiful boys motherless!
Yay hospitals… although that phrase seems somehow inadequate.
I forgot to mention that my hemorrhage was almost completely INTERNAL. That is, my womb was refusing to contract and filling up with blood. How much blood? One-quarter of all the blood in my body–my womb was enormous, having just carried good-sized twins to almost 37 weeks (they were both about 6 pounds and my waist, normally 25-26 inches, was over 50 inches around).
A homebirth midwife would not even have noticed my hemorrhage, much less been able to treat it. The only reason it was even detected is that I was in the hospital on continuous monitoring and they noticed my blood pressure plummeting.
Holy shit. and i’m not sure if its the hemorrage or the 6 pounder twins that makes me say that.
🙂
For my twins’ size–BTW they were also both 21″ long at birth even though they were premature and I’m short–I credit the massive quantities of cheese, buffalo and turkey burgers, yogurt and wild salmon (bones included) that I ate while pregnant. Protein! And calcium! They are your babies’ friends.
Off topic, but curious what the group thinks of this: http://www.npr.org/blogs/health/2015/03/09/390977656/the-gentle-cesarean-more-like-a-birth-than-an-operation
Two problems: (1) the article makes it sound like most C-sections aren’t really emergency/emergent (and I wonder if that is true); and (2) it conveys that failure to progress isn’t a big deal with its own risks.
The other problem is more insidious: it says this method of performing c-sections makes c-sections “more like a birth than an operation.”
More LIKE a birth?!?! As if birth via c-section is somehow not a birth, or not a “real” birth?
I didn’t even notice that. Yeah, the bias is clear.
But it’s both. A birth and an operation, that is. Why should there be this dichotomy?
Right. It already IS both. There is no dichotomy, except in some people’s minds.
If a breast biopsy is an operation, than so is a vaginal delivery. A natural birth is vaginal surgery, and a cesarean birth is abdominal surgery. Each with their own risks of bleeding, injury,, post op infection etc.
Exactly! If women don’t feel like they gave birth because they had a c-section it is BECAUSE of articles like this.
And personally I was very glad for that sheet that separated me from having to see my insides. Sure, it would have been nice to snuggle my son right after he was born but I was honestly just super relieved that he was crying and being checked out by the neonatologist and NICU nurses who were ready and waiting in the OR.
Thanks to the c-section which probably saved his life, I get to snuggle him as much as I want now!
Totally agree. This kind of oblivious reporting in the media bears a lot of responsibility for that. It reminds me of things unconsciously prejudiced people used to say (and still do, though now they get called out on it): “He’s a credit to his race,” “For a woman she’s a great driver,” “she’s as smart as a man,” and all those other little phrases that reveal the speaker’s unspoken (and wrong, and discriminatory) assumptions.
I’ve started blogging about homebirth at babyMed. Maybe I can talk some women out of having homebirths. Please like and share my posts!
http://www.babymed.com/blogs/lana-muniz/homebirth-hasnt-been-safe-long-time
Horrible. I think you should put “unexpectedly” into parenthesis or even better replace it with as expected . Because it is now an expected occurrence.
eg
A baby who died at homebirth in Florida 12 weeks ago, unexpectedly born dead.
would be:
A baby who died at homebirth in Florida 12 weeks ago, was born dead as expected in a homebirth.
Or
A baby who died in Texas 6 weeks ago, unexpectedly born pulseless.
Would be:
A baby who died in Texas 6 weeks ago, was born pulseless as expected in a homebirth.
True. The only person who’s not expecting it is the mum. The midwives mostly know and choose to keep practising anyway.
Eh, most home births turn out OK, 90% or so. So, the expectation is a live baby. Unless of course you’ve actually been monitoring the fetus well enough to notice things aren’t going so great, in which case you hopefully did something like call 911.
Mildly OT: A Paleo cookbook for babies and toddlers has been indefinitely shelved just before release due concerns about the content. From the article on News.com.au – “In my view, there’s a very real possibility that a baby may die if this book goes ahead, especially if [the DIY formula] was the only food a parent was feeding their infant, it’s a very real risk. And [I consider that] the baby’s growth and development could be impaired,” Professor Heather Yeatman, president of the Public Health Association of Australia (speaking to AWW)
“A Paleo cookbook for babies and toddlers”
No.
This concept is ridiculous.
You know what happens in hunter gatherer societies when someone can’t make Breast milk?
1) the baby dies
2) the baby is wet nursed by someone with extra milk
3) the baby is fed chewed up adult food and either survives but is malnourished, or dies.
Nobody has the time or energy to boil bones over open fires to make broth for a baby. The bones are probably going to the tribe’s hunting dogs. Which would be a more valuable asset than a baby.
The way I see it (and I am not an anthropologist) the Neolithic revolution happened all over the world. Our ancestors realised that farming gave them a survival advantage over the hunter gatherer lifestyle. Some of us even developed mutations to allow us to continue to digest dairy as adults-again, because it conferred a survival advantage over those who could not.
Why are these people trying to undo millennia of evolutionary progress?
Fine. Don’t eat goldfish crackers and McDonalds if you don’t want to, and definitely don’t eat things you have genuine proven allergies or intolerances to, but don’t pretend there was some golden age of dietary perfection. There wasn’t, and it certainly didn’t involve feeding bone broth to infants.
Even if they had the implements to make the broth and something to safely store it in and feed it to the baby from (stone spoon, anyone?) the whole idea is moronic. All I can see when I think about this is The Flintstones.
And how could you even get enough calories into a baby with this, let alone everything else they need to grow.
The other problem with the recipe is that it reportedly contains over 10 times the safe maximum daily intake of vitamin A for a baby! (Plus not having enough of other nutrients)
I’m sure there are a dozen problems with it, the first of which is anyone looks at it and thinks ‘oh, good plan’.
But…but…a chef says it’s a healthy way to eat. He should know! 😉
I wonder if the author is any sort of expert in child feeding, or in fact any sort of chef. Much as I love bits of Nigella world, she’s a good home cook, not a chef, and she has given rise to a wave (more like a nasty rash, actually) of similar though usuallly less stylish and fab copycats.
Do chefs have any sort of nutritional training? I’m pretty sure lifestyle gurus don’t have to-what are the qualifications for being a lifestyle guru anyway?
Hey, don’t knock home chefs. The best-ever episode of Iron Chef was the one where the competitor was the woman who brought home cooking to TV in Japan. I read on Just Hungry that she passed away recently. Very sad.
Was that the potato battle with the older lady who finished her 9 different plates, then went around the iron chef to see if he needed help? I loved her.
Yes, that’s the one!
I love home chefs-just don’t want cooking tips from them on tv. We haven’t seen a lot of Iron Chef recently, I’ll look it out.
It’s on YouTube (well, an interestingly dubbed version is).
I watched it today. She was awesome. Total Iron Butterfly.
However, her dessert involved potatoes, bananas, mayonnaise and mustard.
I’m gathering the Japanese palate is rather different to mine.
Oh good golly, it wasn’t Pete Evans again was it? He is seriously off his rocker (and def not eating paleo on MKR!)
Never trust a ripped chef.
‘Twas indeed! I just want to know if his hair products are paleo and ‘chemical’-free. Same with his tooth bleaching.
Is that the one that could kill your liver or is it massive quantities of D? I always forget….
A is hepatoxic. D is toxic in severe overdose, but it’s mostly hypercalcemia. I think. A is also a teratogen.
Paleo people are half arsing it anyway if they are using beef bones.
Authentic Paleo means no domesticated herd animals, wild caught game meats only, no deep sea fish, surely?
I mean, if you’re eating commercially farmed chicken, pork and beef, and shellfish and tuna caught by trawlers, I’m not really sure how Paleo you can really consider yourself to be…
On the other hand, if you’re eating rabbit, pheasant, partridge, wild turkey and duck, wild boar, squirrels, venison, kangaroo, river caught salmon, eels and trout, hand-dived shellfish and insects like locusts and witchetty grubs you might actually have a possible claim to following an authentic Paleolithic diet.
Wooly mammoth. How can it be paleo without wooly mammoth?
You should be allowed to eat anything as long as it’s caught by a member of your extended family with their bare hands. Bow and arrow might be permissible, too, as long as you made it yourself.
What if the dogs catch it? Can we eat a squirrel if they manage to bring one down*?
*The dogs aren’t paleo dogs either. They’re little fluffballs and if they actually managed to tangle with a squirrel it might be the squirrel getting dinner.
Poodles of the Serengeti
My dog can catch a squirrel. I don’t think he’d readily share it with me though…
http://oi62.tinypic.com/j5uxci.jpg
You’d be skinny alright…
Only if you live in a climate where all those animals are native. Is there a place where kangaroos AND salmon AND eels AND wild boar, etc., all coexist?
Good point. It is not as if they’re sticking to strict geographical areas when it comes to their fruit and veg choices, either.
Surely to be strictly Paleo you probably shouldn’t be eating a combination of Africa, Asian and American fruit and vegetables…
And you should definitely be eating *anything* and *everything* edible locally. mmm garter snakes
When Jane Goodall was studying chimps in the wild, one thing she always did was to taste everything they ate.
This makes we think that the paleo diet people are not going about it far enough. They should be mirroring chimp/ape diets
Mmmmm–local AND organic!
Victoria, I think. Maybe Tasmania too? You also might find deer there.
There are no native species of deer in Australia. There are introduced species that have established wild populations. Fallow deer (probably from the UK), red deer (from Scotland and England), rusa (Indonesia), hog deer (India to Thailand), sambar (southern and southeast Asia and some other bits) and chital (India, mostly). There are also a bunch of introduced deer to New Zealand.
Yup! But they’re feral and naturalised, so I may as well eat them. Saving the environment, one yummy meal at a time.
Well you could butcher them and store them in your paleo freezer…just to celebrate the first paleo family: The Flintstones!
https://www.youtube.com/watch?v=2PPf3aaZmUw
Everyone should eat local invasive species whenever practical. Become the apex predator, create a new balance.
The Cane Toad Diet.
Yeah ick. Though the birds flip them over onto their backs and eat them that way, carefully avoiding the toxic bits.
Saw a kookaburra on my walk with the dog this morning, trying very patiently to break open a nut it had so it could eat it. In the end it hit the nut too hard and it bounced out of its beak and away. Hopefully it found something else, the nut didn’t look too promising anyway.
Definitely. Whenever someone claims to be following a paleo diet, ask them what sort of insects they’ve eaten this week, and how they tasted.
See my comment below about Jane Goodall. The one I remember explicitly was when she, after observing the chimps using the stick to get termites from the log, went down and tried it for herself (including using the stick and eating the termites)
I am only partially joking about the ape diet. I’d like to hear the objections as to why it doesn’t make at least as much sense as the standard paleo stuff.
Because the paleo guys aren’t interested in actual history, they just want a nifty sounding reason to eat lots of corn-fed selectively-bred steak.
Now, the diet of a modern ape (living in a nice area with adequate food supplies) would probably be pretty healthy for us.
GRASS fed! Corn fed doesn’t have the right paleolithic omega3/6 ratio.
In my defense, I only know this because I was paid to translate a paleolithic health website once. (I ended up quitting because I wanted no part in the fear-mongering over sunscreen.)
It’s also not really Paleo because Maize= native to Americas and non-buffalo cattle=native to Europe, Asia and Africa.
We should write that book, YCCP. I’m half serious.
I watched a nat’l geo documentary about chimpanzees that featured a primatologist trying out that method, only with safari ants (huge ferociously biting types). He came away bleeding but described them as tasty!
Evil apes using technology to get food that nature didn’t intend them to eat. Sticks are a sign of modern weakness. Eat only what you find by flipping rocks with your bare hands!
I think you’re being a little judgmental of Paleolithic lifestyles. Who doesn’t like handfuls of grubs, carrion, and the hastily consumed remains of dead familial group members? That’s good eatin’, and you get a nifty body odor to go along with it!
The inherent problem with the paleo diet, IMHO, is that, even if we could really replicate it, even if it really was “healthy” for people in paleo times, we aren’t the same people that ate it. Quite a few of us are lactase persistent mutants, most of us have a handful or more immune changes designed to help us live in cities without dying of infectious disease, some of us have alterations in our RBCs to help us cope with malaria (which probably became widespread thanks to farming), some of us have skin pigment changes that let us live at more northern latitudes, most of us, despite what we may think, are able to cope with gluten just fine…we’re just not the same critters as the early people who roamed the plains of Africa chasing gazelles to death and snacking on grubs. Sorry.
Genuine question:
Is there any reason to believe that paleolithic people would have had any problem with gluten had they eaten grains? (and they may have very well eaten wild grains).
I think there is some evidence linking the amount of time a given population’s ancestors have eaten wheat and the risk of celiac disease in that population. But I must admit I made an unfounded leap from that to the idea that it had to be cultivated grain…wild grains would produce much the same result if it were a critical part of the diet.
I like paleo recipes generally because I can only lose weight on a super low carb diet, which a lot of paleo stuff definitely is. So, I’ve found some good recipes and have had good success. I like to take pictures of them with my daughter’s toy t-rex next to the plate pretending to eat it and then I caption it “Paleo Pad Thai”. It delights me.
How is pad thai “super low carb”? Isn’t it all rice noodles?
zucchini noodles!
Because undoing evolutionary process is their thing.
I’ve actually been considering doing the autoimmune paleo diet due to lupus nephritis. I’m just curious what you think about the “leaky gut” theory and autoimmune disorders? I figure it won’t hurt me to cut out the processed foods just for general health reasons but I guess after suffering from chronic autoimmune disorders for so long part of me is also really hoping that eliminating certain foods from diet will help.
I’ve been somewhat skeptical about it all just because I feel like there’s such a huge industry behind it now and can’t seem to find much written about it by actual doctors or nutritionists. I feel like I’m willing to give anything a shot though as long as it won’t do any damage (other than to my wallet). Do you think it could actually be somehow detrimental to my health to give it a shot?
I work on lupus nephritis. It’s a complicated condition for sure, without a lot of good treatment options, but we’re trying. :
The paleo diet isn’t going to change your inflammation. There’s a lot of B-cell dysregulation and autoantibodies going on, and all of the avocado in the world won’t change that.
Are your doctors giving you any helpful guidance?
Dang, that’s kind of what I figured but still disappointing to hear.
My doctors main advice has just been to stay on my meds. They don’t have much of an opinion on diet, other than the general advice to eat healthy. I know from my own personal experience that getting enough rest and good stress management is really important so I try to be cognizant of that.
The main issue for me right now is that I would love to have another baby and while my doctors have said they don’t rule it out, they think it’s a much riskier proposition than my first pregnancy. It’s a whole other can of worms but I tried to stay off my meds so that I could breastfeed my first and ended up doing what looks to be some permanent damage to my kidneys. Pretty much why I really resent the whole “breast is best” message that’s out there – but like I said that’s a whole other rant I could go on!
Very thankful to all of you in the medical community who are working on this awful disease. I know that not so long ago I wouldn’t have been expected to live as long as I already have (10+ years and counting!).
Yeah, that goes along with what I’ve heard from the clinicians I work with – diet only does good if there’s a real allergy, and general well-being is the best that diet and exercise can do (which isn’t nothing for sure, but there’s no magic diet).
“I tried to stay off my meds so that I could breastfeed my first and ended up doing what looks to be some permanent damage to my kidneys”
Oh lord, I’m not surprised you’re mad at the Breast Is Best brigade. 🙁 So sorry.
Oh geez, I nearly did that. I stayed off them while pregnant and I think that turned out to be a mistake too as I damaged my hearing further..
I saw this study that showed more and more women are skipping asthma meds while pregnant. Like a substantial increase over the last decade, despite no evidence of fetal harm from the most commonly used medicines at normal doses and incontrovertible evidence of fetal harm from uncontrolled asthma.
FWIW, every doctor I saw while pregnant was very insistent that I continue taking my asthma medicines.
At the time I was pregnant, I only had a rescue inhaler, and nebulizer as needed, but I got a cold, so I needed it, and the OB said: if you don’t breathe, neither do the babies.
I don’t have the same thing as you, but I have an immune system issue with chronic inflammation. A lot of patients have been trying anti-inflammatory diets but it’s so hard to try and maintain them and a lot of “anti-inflammatory” foods seem to just be based on the latest fad diets. There was a lot of interest when the following info came out, but I wouldn’t know how this fits in the whole scheme of things. I might still bring it up with my specialist and see what they say.
http://news.yale.edu/2015/02/16/anti-inflammatory-mechanism-dieting-and-fasting-revealed
That said, I do seem to be getting hit with irritable bowel syndrome and adult onset allergies, so I’m having to be very cautious with my diet. Some things like shellfish seem to be causing an actual increase in IgA (still not sure if it’s linked but that’s my best guess for now and my specialist is looking further at this). It seems that having one immune system issue can mean that you get more.
I’ve had to cut out raw fruit and vegetables thanks to IBS-like symptoms, it’s so frustrating. Especially when well-meaning people suggest raw juicing as a cure-all for joint and gut issues!!
Thanks for the link! It’s definitely worth at least discussing it with my doctors – can’t hurt right? I have been feelign some IBS like symptoms myself which was another reason I thought maybe on doing the diet.
I would suggest anyone doing any kind of exclusion diet sees a dietician (not a nutritionist, a dietician) to ensure that they get all the nutrients they need from alternative sources.
Not my area of expertise at all.
I’m afraid when it comes to diet I have two major beliefs.
1) A little bit of what you fancy does you good
2) Is there a point in eating nothing but brown rice and steamed vegetables in order to live to 120, if you have to live to 120 eating nothing but brown rice and steamed vegetables…
I’d ask your rheumatologist and nephrologist what they think.
Thanks! I actually didn’t realize that nutritionists weren’t dietitians so thank you for pointing that out! That is actually what was bothering me about the articles I’ve read, they have been by nutritionists and their “credentials” didn’t look like real things to me. I’m actually embarrassed by this because my mother was a dietitian once upon a time so I really should have known the difference.
I agree with your two points about diet, especially the second one, but I guess I’m just kind of desperate now because I really want another baby. This is what kind of pisses me off about all these fads, they really prey on people like me who are just desperate to get better.
If/when you do see a dietician, make sure that they have experience with kidney issues. I know that my mother-in-law is supposed to keep her protein intake under a certain amount per day due to having polycystic kidneys. You really don’t want to get the wrong advice and make things worse, because dialysis isn’t fun. (She’s lucky enough to be able to do it at home, but screws around with her iron supplements and taking her heparin properly *sigh*)
Thanks for the tip! That’s one of the questions I have that I would want to discuss with a dietitian…how would paleo work with the protein restrictions since it relies so heavily on protein? I definitely don’t want dialysis or to need a transplant 🙁
A registered dietician is someone with a 4-year degree in how diet affects health, including courses in math, chemistry and biology. A nutritionist is someone who likes to talk about nutrition.
…and by “nutrition” you actually mean crap about vitamin supplements.
“2) Is there a point in eating nothing but brown rice and steamed vegetables in order to live to 120, if you have to live to 120 eating nothing but brown rice and steamed vegetables…”
If you eat nothing but brown rice and steamed vegetables, it’ll feel like a long life (whether or not it actually was).
So how is breastmilk from a paleo diet mum not optimum? Or is the NCB/lactivist group a whole different sub-set of special? So confusing.
We keep hearing about all this exploitative selling (yes, I know, probably an oxymoron) that can be life threatening: from touting the appalling Gerson Therapy and that Pantry app which is now in doubt after it turns out Belle Gibson may not have brain cancer after all-which in most ways is of course great news.
What is going wrong down under? At least on this occasion it has been pulled up and stopped, which is a plus.
I think it’s the whole “commercial formula is processed poison” set. Because sometimes they can’t breastfeed and can’t find or afford breastmilk from sketchy strangers on the internet, and no milk bank will waste breastmilk on a healthy, full-term baby. So they want to make their own formula, preferably from unpasteurized goat milk.
Exactly! Except this is bone broth and other ingredients due to the no dairy tenet of paleo eating. They’re also promoting the idea of ‘optimum’ diet for preconception and pregnancy.
Thank you for your blog, Dr. Amy. I am a physician also. I have had 2 unmedicated vaginal deliveries in a hospital. When I was pregnant with my 3rd baby, I figured I was in for another quick vaginal delivery until I found out that my baby was breech and my Ob wanted me to schedule a c section. I was upset. I really did not want to have surgery. I actually felt like an animal trapped in a cage with no way out! For a month, I went through every possible labor and delivery scenario in my mind and with my husband and my Ob. Switch to an old Ob in town who sometimes will vaginally deliver breech babies? Allow myself to go into labor and show up at the hospital where there is another Ob who will sometimes vaginally deliver breech babies? Homebirth? What was I willing to risk? My baby’s health? My baby’s life? I read over Ob literature and statistics to figure out the chances of my child being harmed if he was delivered vaginally. I was lucky enough to come across your blog during this time. All of the information I found led me to the same conclusion. A healthy and safe baby was the only outcome that would be acceptable to me so I scheduled my surgery. I am now holding a perfect 8 week old baby boy. I am so thankful that my husband and my Ob were patient enough with me while I convinced myself a c section was really the only choice I had. I am so thankful that I found your blog. During my career, I have seen and heard about so many tragedies that happen during birth and even then, it took a lot research and your blog to remind me that you never know what will happen a child is being born. It breaks my heart to think of these innocent babies who have no chance because their mothers trusted birth. I wonder if it’s possible to start counting how many women and babies you have saved because of your blog. Thank you again!
Congratulations on the safe arrival of your baby, and thank you for putting him first.
Congratulations on your baby. I hope you recovered well from surgery too.
Thanks everyone! Surgery wasn’t horrible and there have been no problems with my recovery. Other than my new souvenir (scar), my body is back to normal! Totally worth it and I would do it again for my little boy.
Scars are beautiful. 🙂
Congratulations on your baby son!
You loved him so much you were willing to do something that terrified you in order to give him the best chance of being safe and healthy.
Go you!
What are the actual number of deaths in the past year at home compared to hospital? Of course if more people are giving birth at home there will be more deaths at home! Knowing that one person can’t keep track of the number doesn’t give any sort of incidence rate or relative risk and isn’t meaningful to a thoughtful assessment of risks vs benefits of home birth.
I should say not number of deaths but rate per 100 or 1000 births…
Also there are way more hospital births than home births … so while you can’t draw scientific conclusions from casual observation, the sheer # of home birth deaths you hear about compared to hospital may very likely reflect the real trend of atrocious intrapartum home birth death rates.
Yeah. I remember Amy did a great post about this a while back – she listed the homebirth deaths she’d read about during the previous year, and ended up by pointing out what the equivalent number of hospital deaths would have been during that year if babies in hospital were dying at the same rate. It would have been horrendous – I think it ran into the thousands. Then she simply asked whether anyone remembered hearing *that many* stories of babies dying in hospital during the previous year. Stark and effective.
Well, we still are waiting for responses on that post where she asked for any story of a baby that died in a hospital birth that would have survived during a homebirth. Nobody wrote a word.
Not quite true. Some of the regular commentors here discussed a couple of cases that were arguably that way. Actually, when I ask the question, I usually ask for three examples, and I concede “that doctor in Texas who screwed up using the forceps” (even though that is an arguable case, and note that his mistake was a failure to do a c-section).
Of course, no HB supporter dared even a peep during any of those discussions.
That is true, you have better memory than mine. I do remember now that you brought up that case with the forceps. On the other hand, if you really need a fórceps delivery… Is home the best place? Really? That baby would likely have died during a homebirth.
Oh it’s very possible. However, this is the ONE case that every single anti-doctor person brings up as an example of how doctors are evil. But it’s also the only case they ever bring up.
So my approach is to concede it as a possible example up front and then challenge them to find a second. Leaves them speechless, because they don’t know of anything else.
You know, I was going to post back and say that I had one – Luke Day, died of MRSA septicaemia in Ipswich Hospital in 2014, which it seems safe to assume he wouldn’t have been likely to contact at home.
Then I googled it to try to get more details, and discovered that his mother had to be induced for pre-eclampsia and went into a full-blown eclampsic seizure during his birth, necessitating his urgent delivery by Ventouse. So, in fact, if he’d been a homebirth he *and* his mother would have been dead.
(Another notable thing about this case was the major investigation into what went wrong, followed by multiple changes made in hospital practice. Not at all a ‘some babies just aren’t meant to live’ attitude.)
I think people brought up the case of the baby who was killed during a forceps delivery in the USA. Funny thing is, if the mom had a CS earlier, there would be no forceps damage…
Well the baby was also just 28 weeks gestation too…
Right, there were a variety of issues. But certainly this was not a situation that would be better planned outside of a hospital.
Forceps are one of the reasons I was so determined to have a scheduled c-section rather than a trial of labor. I told my doctors several times, “If anyone comes near me with a pair of forceps while I’m in labor, I’ll kick them in the teeth. So can we just schedule a c-section please?”
Don’t knock it. I had a forceps delivery after an hour of pushing. Although I think it was more the episiotomy: I pushed twice and the baby was out! I healed really quickly too.
I knock forceps delivery for two reasons: (1) my mother was permanently handicapped by a forceps injury at her own birth–in other words I have a deep personal awareness of the risks forceps pose to babies, which c-section does NOT pose; and (2) women who deliver with forceps have approximately a 20-fold increase in the risk of severe and lasting pelvic floor damage–again, not the case with c-sections.
To avoid either of those outcomes I would kick a forceps-wielding OB-gyn in the teeth twenty times a day. Or, as I ended up doing, fighting tooth and nail for a c-section. (I can’t believe I had to FIGHT for it when I was carrying mono-di twins, but that’s another story.)
Wow, Sarah, that’s an amazing story.
It was this post: http://www.skepticalob.com/2014/04/the-most-powerful-arguments-against-homebirth.html
“These are 40 deaths that I wrote about in the past 2 years. And only the American homebirth deaths. And only the deaths that I heard about.
Homebirth represents approximately 1% of US births. When you look at term births of normal sized babies to white women, homebirth represents approximately 1.4% births. So if you are planning to tell me that “babies die in the hospital, too,” ask yourself if you’ve heard of nearly 3000 deaths of term babies in the hospital in the past 2 years.
Homebirth kills babies (and mothers) and the only people who appear to be unaware of that fact are homebirth advocates.
Thinking about homebirth? Maybe you should think about these babies (and their mothers), and think again.”
Yeah – that’s the one. Very thought-provoking.
I remember when the MANA study came out last year, there was much discussion about the perinatal mortality (which was atrocious). Just as interesting was the intrapartum death rate. The midwives were trying to find contemporary statistics for hospital intrapartum deaths and came up empty. They’re exceedingly difficult to measure because they just don’t happen. Whereas MANA was actually able to provide a number because their practitioners can’t recognize fetal distress and get baby out before the worst happens.
450% more deaths at home than at hospital for low risk babies. If you go to the CDC website you can browse the data yourself. If you use the criteria: white women (majority at homebirth), gestational age more than 37 weeks, more than 2,5 kg at birth, you will get the numbers. The website is a nightmare though, less user friendly than anything in the world, but it works.
There is a paper by Dr. Amos Grunebaun about it as well with the data published in the Am J Obstet Gynecol in 2014. Very good paper by the way. It shows a clear increase in neonatal death rates.
Nice try but Amy is using rhetoric here- she’s not suggesting that her inability to personally track home birth deaths is actually compelling evidence home birth is unsafe.
Amy has analyzed this issue using the best stats out there and the evidence is clear:
For a comparable population, the MANA data show an intrapartum + neonatal death rate of 1.61/1000 for low-risk home birth while the CDC Wonder database shows a rate of 0.38/1000 for low-risk hospital birth.
So that’s a bit of a difference. The contrast for high risk birth is even worse.
Read more: http://www.skepticalob.com/2014/01/homebirth-midwives-reveal-death-rate-450-higher-than-hospital-birth-announce-that-it-shows-homebirth-is-safe.html
I’m sorry, Dr. Amy. I know that working in a field that faces constant ideological attack can be soul-crushing, especially when it’s so often a matter of life and death, and you’re an expert facing laypeople who are, for some reason, in charge.
It must be some comfort to know that you’ve inspired personal change in people, as we see in the comments from people who have rethought homebirth, but still such sad work.
You deserve ten entire cheesecakes. <3
Thank you for caring so much, Dr. Amy. If it weren’t for your tireless efforts in preaching about the dangers of homebirth, I would have attempted a second homebirth even with a previous shoulder dystocia at a prior homebirth. I am so thankful you are doing this. My family is grateful. I am on baby number 5 now, my doctor has offered me a VBA2C in hospital, with complete monitoring. I trust that everything will be fine, the hospital makes me feel more secure. If I wind up with a repeat C-section, I would not mind at all.
Congratulations! 😀
thank you!
Like I have said before. I had 3 healthy pregnancies and homebirths with good outcomes. If I ever knew that homebirth was statistically that much more dangerous I would have NEVER chosen home! I was really taught that if I took care of myself everything would be ok and if it was not ok there would be warning signs or a HB midwife could handle it in time. From the mounting pile of disastrous HB stories this cannot be true.
I am happy to be having this baby in a hospital even though I am an ideal HB patient and it is outside my comfort zone. My mom was ideal OB patient too until her 4th birth when she hemorrhaged in the hospital (and survived). I feel like I would be pushing my luck at this point.Even though it will probably go fine again, I can’t take any added unnecessary risk of leaving 4 children motherless.
Just to be clear, there were no statistics in this article, just some examples!
JJ was repeating something she has said before in the comments section. If you look through the archives, you will find the statistics. They are quite eye-opening, One thing is useful about the anecdotes here; they show that homebirth deaths are due to complications that are rarely if ever fatal in a hospital setting.
I hope it goes really well for all of you. One of the lovely things about this blog is learning everyone’s stories, and this is another example of that.
Thanks for sharing your journey with us.
JJ, that was true for me, too. I had two homebirths, and I had absolutely no idea that I was taking on such a risk. All I ever heard was that there basically are no true emergencies that can’t be foreseen, and that we would head to the hospital long before things went south. Obviously, I have now heard of a myriad of things that can go very, very wrong in a very short amount of time, and I am never going to have a homebirth again.
Congrats on your pregnancy, and good luck for the birth!
This is a beautiful post Dr. Amy! Really poetic. Never doubt that you are helping us as women, you are.
I have a (not particularly close) friend who is soon to have her fourth child, and her second HB. Last baby was 11lb, and she is verging on grand multip status, and the whole thing makes me nervous, but yet the Australian public hospital she lives near (yup, 5 minutes away) has deemed it suitable for her to have this baby at home with their MWs. I have to keep reassuring myself that the odds are still in her favour, and it is likely that everything will be fine. So yeah, the “please, please, please give birth in a hospital” (so they can treat your PPH if required) definitely resonates.
There are many many things that cannot be dealt with at a home birth, and I will never say that homebirth is the right choice for everyone. However, on the spectrum of risk, PPH is one of the things that can be dealt with by midwives.
I think (although welcome correction if I’m wrong) that in the UK midwives attending a homebirth carry the same uterotonics as they would administer in hospital, meaning that there are only a few things they can’t do when managing a PPH that a hospital could. Also in the UK (that’s where I am so can’t speak for other places) even in an ambulance transfer to hospital the midwife remains the lead professional and the ambulance crew assist/follow her instruction, this is because training-wise a midwife is better qualified to deal with an obstetric complication than a paramedic.
Home delivery has a high risk-out threshold, and transfers should happen as soon as the labour/delivery becomes abnormal, or at maternal request. If these rules are followed then homebirth remains at least as safe as it can be, and more stringent teaching of the NMC Code and Midwives’ Rules seems to be needed in some areas.
I am so saddened that babies are dying, and women are dying, that should not happen and in the US especially there needs to be a proper process for registering midwives that requires a level of training, experience, and updating of practice.
In countries where that exists already, a more stringent process of regulating qualified midwives and checking of decision making needs to happen.
I do worry that if we remove the choice for ‘safe’ homebirth it’ll increase the amount of women either free birthing or hiring untrained ‘doulas’ and conveniently forgetting to call the midwife until too late.
They don’t have blood. Moreover uterotonics are useless if even a small piece of placenta is retained. In both the UK and Australia, women have bled to death at homebirth.
No they don’t have blood that’s true. I really want to learn more, so I hope my questions don’t come across as flippant, does anyone know if paramedics carry blood, also if fluid is sufficient to keep a woman alive during transfer, also if the women who died were not transferred sufficiently quickly/at all and that was the problem? How long would it take to get blood during a previously normal hospital delivery where the woman began to bleed?
I hemorrhaged after a miscarriage and they give you an IV in the ambulance. They don’t do blood transfusions. The IV did keep my from losing consciousness again. I think once you lose a certain amount of blood though they can’t keep you alive even with IV/transfusions.
(I am not a medical professional though).
How long would it take to get blood in the hospital?
Much faster than starting off at home! Also, you can get into surgery quickly to have a D and C or hysterectomy. Plus, you are already are set up for an IV in the hospital. That can be used for meds, fluids ect.
They don’t automatically put in an IV in hospitals in the UK, unless the lady needs syntocinon for augmentation, or is on other IV medication. With transfer the woman would still be getting fluids on route as well as medication, although the point about the blood and potential need for D&C/hysterectomy is valid, aren’t PPH’s requiring a hysterectomy quite rare though?
Hysterectomies after birth do seem rare. I don’t know anyone who as had one in that situation. But if I was bleeding to death I would want every life-saving option done to me as fast as possible.
The problem is that who knows how long until the ambulance comes with the IV ect. Then you are still having to actually get into the hospital. Bleeding out can happen fast. I was fortunately waiting to see an OB when it happened to me and only minutes from the hospital.
I think in the USA you get a heplock in the hospital to make giving an IV faster? Still, faster than at home.
I have had all my babies at home but this one is going to be born in the hospital for those reasons. My home can never be the hospital. Even with ambulances and close distances.
I know a woman who had a hysterectomy right after delivery, and another one who almost needed one. She said the doc said it was time for one (i think she was on the way to the OR), and she cried and begged them to give her a little more time b/ c she wanted more kids, so they massaged her uterus a little longer (ouch!) and she didn’t get a hysterectomy.
In my experience, I’ve encountered several women who required a hysterectomy — the saddest being a woman who’d had a long history of infertility, and who eventually gave birth to a severely premature baby, who did not survive — so she was left with nothing, no baby, and no uterus.
Birth is not benign.
No one gets into one’s car planning to have an accident, yet that is what so many who insist on having a home birth are doing: “the risk of X, Y, or Z is small, so the risk is worth it” — while the risk can be almost entirely eradicated simply by giving birth in hospital. When one gets into one’s car, one buckles up, one keeps the car in good condition, drives carefully, observes traffic regulations, doesn’t have three double martinis before putting the key in the ignition.
So just hope you aren’t rare. Things are only rare until they happen to you. Things are only low risk for you until it happens to you. Once it happens to you your risk was/is 100%.
Of course, but life is all about balancing risk, for example up until the point where a hysterectomy was required the midwife has the skills and equipment to manage a PPH while transferring to hospital (oxytocic drugs, fluids, IV access). If the majority of women with a PPH require syntocinon and the bleeding stops, and a large amount more require syntometrine and only a very small number require a hysterectomy then you can’t assess all the women based on the worst-case scenario (or you might as well just section everyone at 39 weeks, in case something goes wrong).
We have very good (usually) investigations into poor outcomes in maternity care, the recent awful events at Morecambe Bay are unusual and they point to failings from literally every corner, and improper investigation and I hazard a guess poor or fraudulent record keeping. But again, the bad outcomes are what makes the news. You could likely find an area with a high homebirth rate and a very low rate of poor birth outcomes, or a hospital trust that is very good at investigating neonatal and maternal mortality and morbidity but still has a high stillbirth rate.
There are many factors that could mean that a woman or baby is compromised at a homebirth. Obviously bad clinical care is one, but another big issue currently is that women who want a homebirth despite medical advice must be provided for, and women who refuse to transfer despite medical advice cannot be forced. There will be women who will choose to free birth if they do not get their desired birth, and that is exponentially more dangerous than a planned homebirth with two or more qualified and experienced midwives. It’s all about balancing risk. Again I think that’s different from the US because a midwife once she begins to care for a woman has a duty of care until she hands over to a more qualified person (OBGYN)
“Another big issue currently is that women who want a homebirth despite medical advice must be provided for.” I’m not sure I agree with this. What about the medical providers – should they be forced to take part in a disaster they know is going to happen? Is it okay to traumatize them like that?
No I don’t think they should, but that’s how it is in the UK…midwives can inform the women of risk, they can advise a hospital birth, or a birth centre in a hospital birth, but if the woman insists on a homebirth, then care has to be provided. Often there will be special plans in place, extra midwives there, a supervisor of midwives there, but it is ultimately the woman’s decision. You can’t refuse to care for someone, you’d potentially be liable as being negligent.
I understand that point of view of it, too. I guess it just seems unethical to me for someone to make that choice and force others into such a position.
In fairness, in that situation there would likely be a consultation and the most experienced midwives would probably attend, with a midwifery supervisor as support, the risks would be discussed with the woman and family prior to the birth and the midwifery team would discuss a care plan to try and anticipate potential problems, throughout the birth itself everything would be documented (they may have someone acting as a scribe) and the hospital delivery suite co-ordinator would be continuously informed. Although not fair on the most experienced midwives, I think the rationale of this is that they have seen a lot of births, and a lot of births go wrong, they are more likely to cope with it than a newer midwife and more able to see the limits of their practice so if they do everything they can and it goes wrong because someone with serious medical issues refused a hospital birth, or refused to transfer, or refused medication…they would be able to cope better. Although that’s rubbish IMO all the midwives I have ever met take it incredibly hard when a baby or woman dies or is hurt, and will often think they didn’t do enough, in whatever situation.
A former blogger, A Midwife’s Muse, wrote quite a bit about how repeated staffing cuts meant that community midwives were so thin on the ground in her area in the UK that in the event a woman demanded a homebirth even if not suitable, a single community midwife could find herself alone at the birth — there simply was no other midwife available. Eventually Midwife’s Muse retired because she felt she was overworked and at too much risk — which, I’m sure, further depleted the number of midwives in her area.
To each their own, but I’d prefer not to die of something that could have been prevented. I don’t want to die in childbirth the way women used too.
It would be interesting to see, if you could find an area that has a high home birth rate and very low rate of poor birth outcomes as compared to a group with similar risks in hospital. In the US areas with high home birth rates also have poor outcomes. It’s been mentioned in several posts here that the Netherlands which has a high home birth rate also has poor outcomes (when compared to the hospital group).
Regtettably, the perinatal mortality rate of 2-3 times the low-risk hospital rate is proving to be a robust finding. Personally, I believe that far fewer women would be willing to do a high-risk home birth if they could not find providers to attend to them. While I believe that s woman has every right to choose how and where she gives birth, she is by no means entitled to a care provider. Adhering to risk criteria and documenting why the patient is a poor candidate for home birth is what defines an ethical provider.
I can also speak a bit to pph. I had a cervical laceration during my first birth. I arrived at the hospital at 9 cm., and as a result, did not even get a heplock. I would have given my right arm for pain relief during the manual examination. Of my uterus. I could still get utero tonics, but as Dr. Amy pointed out, they do not work if you have retained placenta or deep lacerations. So yes, a midwife could manually remove placenta at home, but it is excruciatingly painful and frightening to go through. I was also fortunate that I did not need blood, but it was a near thing.
There is a lot that a midwife can’t do in a PPH that I can do. In hospital, as soon as a patient starts to bleed, they call for the OB, STAT. Because we are better trained. I can order tranxemic acid, I can explore the uterus, I can repair cervical tears, etc. In theory they can put a Bakri catheter in, but I have never seen them do it. I can order blood (they can’t – in Canada), so when an actually PPH occurs, you want an OB, not a midwife.
A very compelling point indeed! Several times I have been that “rare statistic” and it was so discouraging. I don’t mind being an anomaly in some ways – like for good things or mildly irritating things-but life-threatening traumatizing things? NO WAY!
The thing about the “rare statistic” is that there are so many possible “rare” events that the chances of having one of them is not quite so rare.
Even if the chances of something happening are 1 in 10 000, if there are 100 such things that have a 1 in a 10 000 chance, the chances that you would have none of them is up to 1 in 100. Despite that whatever happens only happens in 1 in 10 000.
At a hospital with blood bank máximum time I have waited 2 minutes. Sometimes it included people actually running through the hospital. That is the time it takes to physically get whatever is available to the place where it is needed. It can be 0 negative, same blood type if you know it in advance or cross matched in advance. If you do not have it cross matched in advance, same type is like 10 min, 15 min tops and cross matched might be hours if you have a minor incompatibility.
I’m not a medical professional, but I know when I went to the hospital in labor the first thing the nurse did was take blood to determine my blood type in the event of an emergency..So, they knew the type and that they had a match before anything happen. A woman just arriving at the hospital will have to be tested before they can give blood.
Again I’m not entirely sure if group and save is done as standard for women having normal births in delivery suite, I might be wrong though, I think they keep O Negative blood in the delivery suite fridge for emergencies, but not sure how much, and blood group is on file and in the hand-held notes so that might speed things up =/
It is my understanding that in the U.S. a woman can arrive at the hospital during a homebirth transfer with zero medical information and chances of the blood being typed before hand is slim. So, doing that in advance might make a difference.
Yeh, unfortunately comparing the US and UK systems is like comparing chalk and cheese, because while the UK system has flaws and funding is a huge one, there is a requirement for a degree or postgraduate qualification for registered nurses, and all midwives MUST have that in order to register, and unregistered midwives are not allowed to legally practice. Midwives must also be meticulous with record keeping, throughout the antenatal and postnatal periods as well as during labour and birth, record keeping is actually a requirement of registration and records can be checked whenever (although I don’t know how often that happens if it’s not because of an investigation). Student midwives are taught and examined on record keeping as part of their clinical skills, so all women who access antenatal care should have good records for the hospital.
Sadly there are some horrendously unqualified people calling themselves midwives in the US and it really shocks and disgusts me that they’re still allowed to do it. I feel incredibly sorry for the real midwives who worked incredibly hard to achieve their qualifications and care about women and babies that their profession is being cheapened in that way.
When I studied in the UK in the mid-70s it indeed was the case that State Certified Midwives had to also be State Registered Nurses. It is now my understanding that most midwives in the UK are direct-entry, doing a three year course but are NOT nurses. Other standards have been relaxed, such as allowing primips to have home births, which was absolutely prohibited in my time there.
PPH is terrifying, even if not particularly severe. Remember that between a quarter and a third of a mother’s blood passes through the uterine artery every minute. It takes no time at all, if the hemorrhage is severe, for a woman to go into shock. Even in hospital there are a few nail-biting minutes when things go south. Just imagine what it’s like when you begin counting the minutes from the time you call the Flying Squad until the patient actually leaves the home…and until she gets to the hospital.
Women who have a homebirth generally do not have an IV prophylactically, or a hep lock. Trying to put an IV into a woman who’s rapidly bleeding out is great fun, believe me, and IM administration of oxytocics takes quite a while to take effect.
Blood is a risky product that is not kept around to be given easily. It is a life saving product that we have limited resources. Packed red blood cells (the oxygen carrying cells) are kept frozen, and only thawed (to refrigeration levels) when they are needed. If we don’t give the blood, and it has been out the blood bank too long it is “wasted” and can’t be used. There are other products given during a hemorrhage, like fresh frozen plasma (contains clotting factors), platelets (sticky blood cells) and so forth.
I work in a system where midwives are integrated into a system, but even still, hemorrhage at homse scares the crap out of me. There is very little that scares me more than a call that an ambulance has been dispatched to a homebirth with a postpartum hemorrhage. We pull charts, inform the OR and meet them as they come on to the floor. Out midwives are good, IVs will be running, drugs given and blood drawn so it can be sent stat for crossing. The ambulance doesn’t add a lot of additional resources, they are not well equipped for obstetrical emergencies, and we often have to debrief the paramedics because it is traumatic for them too. However, often the patients arrive unstable I have a lot of work to save them. I can’t image what the CPM cases who be like, they are not have as well trained.
Labour and delivery are potentially emergencies, why would home be a safe place. One or two midwives can never provide the same level of care as a whole team in the hospital
This, exactly! Thank you!!
(and thanks for the reminder to donate)
Mattie, do you remember what happened to Amanda Holden (minor celebrity in the UK) at the birth of her youngest child?
She had a massive PPH (I think either praevia or accreta) during her planned CS and required so much blood that the (major London hospital) where she delivered ran out of blood and more blood products had to be couriered across London for her. I think she ended up getting more than 30 units.
There is a reason that they call is a massive transfusion protocol. One bad PPH can easily go through more blood than a major MVTA.
A person can react to any blood, including O negative, due to minor antigen incompatibility. In cases of extreme need, where the patient will die before the blood typing can be completed, yes, they give O neg and hope for the best, but it is, shall we say, suboptimal. Much the same problem with a person coming in with a note on file about her blood group: you still don’t know about minor incompatibility.
The other problem is that if a person is actively bleeding out, their veins are likely to have collapsed and simply starting an IV can be hard. This is why most hospitals require an IV at the start of even a low risk labor: because if something goes wrong and they need to give blood/fluid NOW they don’t want to be delayed by having problems finding the vein. A type and screen to identify which blood could be given if their was a sudden hemorrhage is also performed at the same time. This makes things go MUCH quicker if catastrophic bleeding does occur.
The first thing they do when you arrive for a hospital delivery is type and cross you for transfusion if necessary. Of course most women won’t need this, but they can order blood for you in short order if necessary, and it is ready on an emergency basis.
If you are transporting from home, they do not know your blood type/antibody status. There is NO WAY you will get a transfusion in time if you are transferring from a home birth, especially if the midwife is not recognized by the hospital.
They actually checked for blood type about midway through my pregnancy. They may have done it again just before my c-section but everything happened pretty quickly then so I’m not sure about that. I imagine that since they had it on file already they might not have needed it done again. I do vaguely remember them taking blood from me though but not sure what it was for.
Either way, it seems a bit silly to wonder whether a woman laboring at the hospital would get blood faster than a woman who needed to be transferred from home. Isn’t it pretty obvious?
And now that’s Type O- blood that’s not available for an accident victim…
Paramedics don’t normally carry blood in the US, or at least not much. Given that a bad bleed can lead to a woman bleeding out in 10 minutes, paramedics won’t have nearly enough blood to save a life.
At a hospital, they’re basically ready to go if it looks bad.
Paramedics don’t carry blood in the UK.
They’ll usually have a maximum of 10 litres of crystalloids and MAYBE one or two bags of colloid in the ambulance.
A pregnant woman with a torrential PPH can lose 600mls of blood a minute. Even if uterotonics are administered, in a worst case scenario (let’s say placenta accreta which had not been diagnosed antenatally) it might not reduce the blood loss much.
If it takes even 5 minutes for the ambulance to arrive and 10 minutes to transport to hospital, a woman bleeding at that rate will be dead before she reaches the ED. Even if they put up 2 bags wide open with pressure bags, IV fluids are not blood, and she’ll have lost her entire blood volume in under 10 minutes.
Paramedics don’t carry blood. They have no way of figuring out your blood type fast enough to give you a match, they also may not have room for the necessary equipment (blood has to be kept cold and they would need some of all eight types), and most blood products have very short shelf lives, so putting a bunch of blood on board an ambulance where it probably won’t be needed just means wasting blood.
Fluid probably could keep most women alive during transfer–I lost 1/4 of my blood and still only needed fluid, not a transfusion–but once you’ve lost enough blood, your veins “deflate” and it’s very tricky to get an IV in to deliver the fluid.
So at best some time (and thus more blood) is lost trying to get an IV in, and at worst it’s not possible to get it in and the woman dies. That’s why hospitals give you heplocks–IV ports on your arm, ready to be hooked up if you need it–during labor or just prior to your c-section. It’s easy to get an IV port in before you start bleeding, but it gets harder and harder the more you bleed.
As for how long it takes to get blood, in my case they had it right there just in case–I delivered at the same hospital where I got my prenatal care, so they checked my blood type well in advance–but I didn’t end up needing it.
Dr. Amy, what is HBAC?
Home birth after c-section 🙂
At the hospital I delivered my blood was typed during my first trimester. Before my elective C-section it was typed again and cross-matched, there were three units waiting for me to use them prepared and ready. I ended up not needing them but they were there just in case. That is impossible to have during a homebirth.
Homebirth midwives don’t have blood, they don’t have IV fluids, and even if they did have either of those, they don’t put heplocks in before the birth, which greatly reduces their ability to actually get blood or fluid into a patient. Oh, and if the bleeding is internal, they may not notice it in time (see link below about the mom who died that way in a home birth), because unlike hospitals, or US hospitals at least, they don’t continually monitor mom’s blood pressure during recovery.
I’m speaking as someone who lost 1/4 of her blood internally while in recovery, DESPITE having been given Pitocin preventively, and went into hypovolemic shock, which is universally fatal unless IV fluids are administered in time.
Fortunately I was being monitored so they noticed the problem quickly, and I had a heplock, so they didn’t have to deal with the exceptionally difficult (and sometimes impossible) task of trying to get an IV into my deflated veins.
Fortunately they had already given me Pitocin (how much more blood would I have lost if they hadn’t?).
Fortunately I had three doctors working to save me–I will always remember that image, three silhouettes bent over me working diligently as I begged them, in a panic, to please please please make me warm (I’d never been so cold; blood loss will do that to you)–and there were still doctors there to ensure my newborn sons were ok too.
Long story short… fortunately, I was in the hospital.
Unfortunately for her and her family, Caroline Lovell wasn’t:
http://www.theage.com.au/victoria/i-should-have-called-ambulance-earlier-midwife-tells-caroline-lovell-homebirth-death-inquest-20140612-zs5j6.html
It enrages me that Australian hospitals are encouraging this. It’s just a sign of how entrenched NCB has become in the public, midwifery-led system.
Even women who are planning to give birth in the hospital are expected to labour until ‘active’ at home…even if it is taking days. In my family alone two babies have nearly died and one of my cousins nearly died after laboring at home until things were dire. Both resulted in emergency cesareans, the very thing these midwives and administrative are so hellbent on preventing.
I agree, it’s terrible to watch this trainwreck in progress. The Australian NCB movement fought for this to happen (and are still pushing for more public funding and support of homebirths) and it seems to have infiltrated the health system in a way I wouldn’t have thought possible even 10-15 years ago, when I had my kids. What struck me even back then was that Australia was already rather hands-off and low intervention when it came to pregnancy and birth, compared to some other countries whose health systems I’m familiar with. It really didn’t need further paring. But what is that saying? Never underestimate the power of stupid people in large groups… or something along those lines? It seems to fit the NCB movement and its achievements. The sad thing is that it will probably take several more years and numerous preventable deaths for people to wake up and realise that this wasn’t such a bright idea.
Corrections:
“whether the caregiver knew that the baby [was] dead before birth or was not expecting it.”
“Yhe mother died …”
Thanks!
I think it is interesting that you liken it to Russian roulette. In many ways the comparison is more apt than you realize. I have heard that if the gun is perfectly balanced then the bullet should probably be on the bottom after spinning the chamber–making it safe(r) to shoot yourself. So Russian roulette with a perfectly balanced gun is safe–just like home birth is safe as long as your body is perfectly made for birth. The sad truth is that both guns and women’s bodies aren’t perfect.
Maybe this has been posted here before? An OB-Gyn in NC who focuses on home births has been temporarily ordered to stop practicing after a third baby died under his care: http://www.citizen-times.com/story/news/local/2015/03/06/asheville-doctor-disputes-claims-babies-deaths/24513937/
My mind is boggled. Does he also deliver in the hospital? or does he just do homebirths?
Not according to this NC Medical Board document. https://glsuite.ncmedboard.org/DataTier/Documents/Repository/0/0/9/8/39961e1f-59de-4951-b507-909b9ef1867b.pdf
one of my partners trained in Asheville (there is a VERY good OB residency there), and she says he was working out of a van.
https://www.youtube.com/watch?v=IAhGUXeOz0U
There is a reason he doesn’t have hospital privileges, I suspect
So that is basically false . . . IF he was ‘practicing out of a van’ (which really would mean he was doing house calls for a homebirth practice, because really do you seriously think he was doing births in a van?), it was only in the last year or so. Before that he was with MSF in Sri Lanka & the Sierra Leone doing Cesareans & supervising local staff, and before that he had a very regular office space with all the bells & whistles (meaning ultrasound, labs, blood pressure equipment, just everything regular in a medical office). I never received care in any place besides a medical office until the actual L&D and that is true for several other Fed Up moms. Really the fact that he WAS a pretty mainstream OB provider is what proves that HB isn’t safe even if you have WAY more training than a CPM . . .
I’m sorry. Seems I hit a nerve. I didn’t realize you were his patient. I don’t know how you can know this is false however, since it seems by your comment that your interactions with him were several years ago.
When were your partner’s interactions with him? He was my doctor 5 years ago. I can know he was not practicing out of a van the same way I know none of my current doctors are practicing out of vans. Because my appointments took place in a medical office. I think he had a pickup, but I never really look in the parking lot when I go to the Dr. Then I occasionally corresponded with him while he was in the Sierra Leone & Sri Lanka because I am a MSF supporter at least philosophically. I conceded that you may be correct that he may have been doing house calls, but only very recently. And I have no knowledge of it. When my third son was born we spoke & he had not yet resumed his US practice. That was only like 9 months ago.
He was for sure the absolute safest OOH provider in WNC at the time & definitely the most legal. Unfortunately seems like it was not safe enough. The NC scene is CPM dominated & that is who All my other OOH options were. I so sorry this ended how it did, but I am still so grateful that CPMs committing misdemeanors were not my only OOH option.
Oh dear. So we are to assume then that the three deaths occurred just since he resumed his US practice….nine months ago?
How can he live with himself?
He can live with himself because narcissists always find a way to rationalize what they do. Rules and guidelines are for regular people, not heroes like him! Why he rescues women from having to use a CPM! Why he risked life and limb to work with MSF (and it’s just a total coincidence that the overseas opportunity came along just when the fire started to get hot under his butt).
“Really the fact that he WAS a pretty mainstream OB provider”
Sounds to me that this guy was NEVER a pretty mainstream OB provider. Quite the opposite.
I had to read his statement on the issue several times before I realized that he was talking about more than one death. He seemed to be trying to make it sound like only one baby died, perhaps to minimize how poor his outcomes are.
It’s especially discouraging when a doctor gets involved in this lunacy.
However, at least he is being held accountable.
They didn’t go into details on the “sub-standard care” he provided, but I am going to go out on a limb and suggest that the issue is that he puts ideology over everything else.
And it is an example of how it’s not about medical training, but ideology.
Please remember Vylette Moon. She died because of midwives at a free standing birth center. Which is akin to a homebirth in someone else”s apartment.
if anyone has a username on cbc.ca and wants to put a link to this post on this article, i’m all for it.
http://www.cbc.ca/news/canada/british-columbia/home-birth-often-safer-than-hospital-birth-says-midwife-soo-downe-1.2988742
Why must I live in the hive of woo…why????????????????
just lucky?
In good news tho, judging by the comments the majority of those who care to comment aren’t buying it and there is quite a bit of backlash against her advice as being self-serving.
I’ve commented, Ms. Downe obviously is oblivious to the whole Kirkup report and has come to BC to spout off philosophies that are no longer welcomed in the UK.
Can these incompetents be charged with fraud? They are representing themselves as knowledgeable professionals; they are assuring their clients that their product (home birth) is safe; and they are charging a hefty fee for it. I would have thought that anyone harmed by their product, would have an open-and-shut case.
Imagine I set up as a skydiving instructor (I have never skydived in my life). I take your money. I promote myself as safe. I take beginner skydivers who have no idea what qualified instruction looks like. If anyone questions my unorthodox methods, I defend them as “a new way of skydiving”. I insist qualified instructors make skydiving more complicated than it needs to be, so they can charge more. Now, let’s get into that airplane!
I would definitely face civil, and possibly criminal charges for the resultant deaths. Why do these murderers get a pass?
I think you may be onto something here…after all, skydiving is just falling out of a plane, right? How hard can that be?
you died because you didn’t trust free fall?
Trust gravity!
Heh. I trust gravity a lot more than I trust birth. Gravity is reliable, as long as you know where you are relative to the nearest massive object. Birth…not so much.
Studies show you’re as safe or safer without those gravity-intervention devices…
http://www.bmj.com/content/327/7429/1459
Right. Falling is perfectly natural. Why should we treat it as an illness?
Also, your link is perfect for the next time any antivaxxer asks for double blind placebo controlled trials…
That’s my primary use for it, but Tosca mentioned skydiving as an analogy and I couldn’t resist.
This is not a bad analogy, except that gravity will kill you pretty much every time.
And anyway skydiving instructors are awesome-have a look at this recent skydive where the quick thinking of the instructor saved his student from serious injury http://www.abc.net.au/news/2015-03-02/skydiver-saved-after-passing-out-during-dive/6273694
It’s because they don’t carry insurance. It might be a clear-cut case, but since there is no profit to be made, its hard to find a lawyer to take it on, and even if the parents/family of the injured won, the midwife in question would probably just declare bankruptcy, move to another state, assume a new name and go on practicing.
It’s the natural childbirth advocate crowd’s rallying cry of “some babies just die” that makes my blood run cold. Yes, some people die. We all die, actually, but the entire point of healing, since the dawn of civilization, has been to stop that as much as possible. And if it’s possible, then WHAT THE HELL? Seriously, the neanderthal medicine man is looking at you side eye.
I work with very sick patients. People that despite all the interventions and medical knowledge in the world are likely to die. I never ever have said “some patients are meant to die”. I have said “I am so sorry I could not help…”, “there is nothing we can do to prevent it…” But I have never ever said “some patients are not meant to live”.
Also, I’m sure there are people in your field who are working to change these outcomes for the better. There are incurable cancers, but people are working to make your chances better all the time.
Dr Amy, are you sure the Texas maternal death was a home birth? It’s unclear on the husband’s blog.
I’m only asking because she was actually my sister-in-law’s friend, and while I knew her death was childbirth related I hadn’t realized it was a homebirth.
Dr. Amy doesn’t make things up or make wild assumptions. She only writes about situations where the facts are verifiable.
Perhaps the husband doesn’t want to discuss or highlight the
role that home birth played in this tragedy.
It’s perfectly reasonable for a reader to question it, especially as the blog didn’t explicitly state that the planned place of birth was not at a hospital.
Looks like the blog’s author has figured out that a lot of clicks are coming from skepticalob.com now.
I thought so too. And it sounds like just getting through the day is taking everything he has, so where it happened may not even be on his radar at this point (or at any point, if he doesn’t see it as relevant).
I was told that it was a homebirth attended by a CPM and two students.
Thank you!
had i chosen to go the homebirth route, my colistasis would have gone undetected, putting the life of my baby at risk. my OB induced me at 37 weeks. then, the placenta was necrotic and i had to have an emergency DNC after an otherwise, and thankfully, uneventful birth. could have ended up with both of us dead if i was at home. i cannot believe there are people in this day and age that shun science and statistics and believe it won’t happen to them. i didn’t think either of those outcomes would happen to me, but boy was i glad to have a knowledgeable OB taking care of us. if you want to have a midwife, fine, that’s your choice, but make sure it is a legit midwife and go to the hospital. insist that no one come in your room, shun the nurses and medications if that’s your cup of tea, but please, at least be there in case something goes wrong.
I’m a fellow cholestasis mom, and I am grateful everyday that I gave birth in the hospital. Thankfully, my delivery and postpartum recovery were uneventful.
What’s scary is that before I got pregnant, I was attracted to the idea of an out-of-hospital birth. That changed as soon as I had a positive pregnancy test. I *knew* I needed to give birth in the hospital, and I’m so glad I didn’t go against that.
It’s because home birth is getting more popular. In 2013, there were 22,465 midwife-attended home births and 9171 unattended home births. In 2008, there were 12,220 midwife-attended home births and 5,913 unattended home births.
That’s an 84% increase in attended homebirths just five years, nearly doubling. (The total number of births was slightly higher in 2008, but very similar.)
And when you try to track the deaths, no matter how you do it, you’re going to undercount. If you track neonatal deaths, you miss the intrapartum deaths. If you track intrapartum deaths, you miss the term stillbirths that could have been prevented through better care. And the preventable serious complications just can’t be counted at all.
Except, you can count Portland. Oregon seems to be the only place counting correctly, which is horrifying, given their numbers.
Unfortunately, I think it is one of those things that will get worse before it gets better. Also, most unfortunate I believe it will take what Dr. Amy suggested to make it no longer the cool thing to do.
Even my most rational friends fall for parts, if not all of the NCB rhetoric.
I’m 7 weeks pregnant. Fourth pregnancy. One live child born at 33 weeks with a NICU stay and developmental disabilities, one early miscarriage, one late term miscarriage. I’m on Lovanox, Zofran, and seeing my CNM (wife) and Maternal Fetal Specialist (husband) team every other week on a good week. Last week I saw the wife twice. I couldn’t imagine going through all this work only to deliver at home! Pregnancy doesn’t garauntee a baby, labor does not garauntee a baby. When are women going to realize that? I fall apart when I hear stories like this because I don’t know what a healthy baby looks like for myself and my husband, and we are proactive in our healthcare.
I hope that your pregnancy goes well! I will be thinking of you.
Best wishes to you! I hope this pregnancy finally teaches you what a normal, “boring” pregnancy looks like!
I could have EASILY been one of the statistics. What saved me (and my daughter!) was that I came across the crunchy kool-aid too far into my first pregnancy to plan a home birth. I got just enough into the woo to blame myself for the c-section I had– it was because I hadn’t done Webster chiropractic or spinning babies or enough prenatal yoga. I had a completely healthy, uncomplicated pregnancy, but my daughter was just asynclitic, and that’s all there was to it. Had we been at home, there’s a pretty high chance obstructed labor would have killed or maimed one or both of us.
take a look at this
http://en.wikipedia.org/wiki/Asynclitic_birth
Hah, a bit of disagreement between the writer and the editor (see “talk” section)
I love how you could tell how much restraint the editor was showing, too 🙂
In any case, all the “skilled midwife” in the world doesn’t help when your labor simply never progresses. Her head wasn’t pressing on my cervix, ergo, I didn’t dilate. Like, at all. I agreed to a c-section two weeks postdates after the second failed induction.
I am sure you would have been sensible enough to transfer at some point before you died of obstructed labor!
That’s the problem. It’s not up to a mother to be ‘sensible enough to transfer’, that’s the responsibility she places on the Midwife. Left alone, I would presume most mothers would identify a need for transfer, but that doesn’t mean it would prevent fetal sequelae or maternal damage.
Not me – I can attest that the pain of unmedicated labor was enough to push me out of mind. I wouldn’t have been able to tell if anything terrible was happening or not. I practically at home, in a freestanding birth center. All ended well that time, but I recognize now that it was luck of the draw.
Oh I am agreeing with you in that it isn’t the responsibility of the mother to know when to transfer. I’m disagreeing with Therese in two ways: #1 Not up to mother to know when to transfer, #2 Even if a mother doesn’t die of obstructed labor, doesn’t mean there wouldn’t be long term sequelae for her or her baby by the time a transfer occurred.
Most, but probably not me. I’ve twice gone in for a check up and been sent to the hospital because I was in labor, more than 5 cm dilated. I’ve also been admitted for preterm labor after going in with what I thought was a very mild UTI, and my husband kinda talked me into not waiting till the office was open.
I am very, very bad at recognising labor.
There are multiple women who have lost babies or nearly done so, who have said that their midwives deliberately misled them to believe things were fine, even after asking for a transfer. When we are relying on ‘caregivers’ who prioritise ideology over the welfare of their patients no matter the cost, informed consent goes out the window.
http://www.skepticalob.com/2014/03/confessions-of-a-medwife.html
My comment was addressing the absurdity proposed by Therese that minimized the risk of Obstructed Labor in her response to Amy. I’m all too aware of manipulative attempts on behalf of midwives at homebirths, as well as just how far “five minutes away” is in terms of morbidity & mortality in homebirth. Simply put, I’m a Medwife and as anti-homebirth as they come.
That blog from the widow is heartbreaking. That poor, poor family.
It really is. I read the whole thing before I realized how much time I’d spent on it. It is heartwrenching.
No matter how low risk you are, there’s always a not so insignificant chance of complications during labor. My cousin is very healthy; her daughter was born full term a couple months before my son, with the umbilical cord wrapped 3 times around her neck. Fortunately, my namesake was born in a hospital, and she seems to have come out of it pretty well. (She’s only a year and a half)
Just wanted to say – Thank you for what you do. Reading these two paragraphs made me so sad:
“Please, please, please give birth in a hospital. You
might not like the experience; the chance of ending up with
interventions is high; the chance of ending up with a C-section may even
be higher than it should be. But the chance of ending up DEAD (you or
your baby) is very, very low.
I am so weary of writing about dead babies who didn’t have to die,
reading soul crushing stories of mothers who risked their babies and
lost, and contemplating the anguish of small children growing up
motherless.”
And I just wanted to say that it is so clear how much you care for mothers and babies and that what you do does make a difference. It changed my mind. I know it has changed others’ too.
Thank you, Dr. Amy.
Yes. Me, too.
Dr. Amy, your blog has increased my interest in not just having all future births at a hospital, but in ensuring that they’re OB-attended (not even hospital midwife-attended) as well. Thanks so much for all that you do to promote safe birth.
I find it so ironic that as a Medwife, I would be so leery if a family member chose a hospital-based CNM for her care. I do know a few other Medwives I would feel comfortable having attend a family member. But for the general public, there is no way to tell the difference and as a Medwife I couldn’t carte blanche recommend you to do otherwise with Midwifery in such a sad state of affairs.
Right, but if the choice is between a homebirth and a hospital based woo CNM…the later is at least at the hospital with other care providers close by!
That didn’t work out so well for several families at Morecambe Bay though, did it?
Hands down Hospital-Based CNM over Homebirth CNM, but even in the hospital there is no guarantee as to what influence the woo will extend. I rarely have mothers transfer out, but recently a mother chose to transfer out to a ‘real midwife’ (her words) at term because she found a hospital-based CNM who was willing to await the onset of labor in the event SROM occurred four days prior. Why? Woo.
I keep thinking more and more about Morecambe. We’re now in the Canadian system after having my son in the U.S., and it seems like so many of my mommy friends took the hospital midwife route. Morecambe reminds me that I’m not interested in hospital midwifery, but I have no doubt that when I ask for OB recommendations in my mommy group, that I’ll receive a litany of midwife recommendations instead. Not interested, but thanks!
As evidenced by my multiple comments on a prior post, I can’t seem to stop thinking about Morecambe either. All of my children’s births were attended by physicians and I am very grateful for their expertise and care. I’d be intimidated by the constant underlying suspicion of ideology if I were seeing Midwifery care too. It shouldn’t be too difficult to locate an OB who meets your needs and in response to the Mommy groups, you can always respond with a “Yeah thanks, but I’m an Ob kind of girl”.
I’ll probably respond along those lines, and/or something about being high-risk.
I don’t see where Mac ever claimed anything about guarantees of anything. The comparison was woo in the hospital vs woo at home. The situation at Morecambe Bay doesn’t say anything about that.
I didn’t claim Mac guaranteed anything. I inserted my own observation and disappointment that the consumer cannot be assured immunity from influences of the woo, even in the hospital.
In response to Bugys’s decision to use OB care for future pregnancies, with no consideration for Hospital-Based CNM care, I agreed. As we have observed in Morecambe Bay and elsewhere, Hospital-Based Midwifery does not exempt it from ideology. In the case of Morecambe Bay, the Midwifery care was “at the hospital with other care providers close by” as Mac said, as though it would be protective from Woo. It wasn’t. I concur with the premise of Dr. Amy’s post and pleas for women to seek hospital-based care. However, the results of Morecambe Bay investigation show even in the hospital, ideology has lethal consequences. It’s the ideology and Midwives either embrace it or reject, but location of service is no guarantee of knowing whether or not they do.
I delivered in the hospital with CNMs who worked under and reported to OBs. Ironically, they were the ones who pushed my induction forward (cholestasis) when the OBs wanted to wait. I think, however, it was more that the OBs were older and had outdated information while the midwives were newer and had the new information.
That’s an interesting perspective. For all the ideologues who claim we overmedicalize pregnancy and birth now, I say we have so much more data to identify risks factors in pregnancy, as well as the antenatal surveillance and interventions to mitigate those risks. For the record, I hate Cholestasis. Miserable mom and feels like a ticking time bomb trying to get to early-term for induction.
Yes, my daughter told me, at 39 weeks, that her underwear felt unusually damp for several days, but no “gush” of fluid. This was her second pregnancy, first was a C/S for breech; this time she was vertex, and hoping for a TOLAC. Knowing that vaginal secretions can increase toward the end, but that she could also be leaking amniotic fluid, I sent her to be checked. Dr. was unsure. Pharmacy-purchased test for SROM was also equivocal. Advised going to L&D. There, the head of OB [who knows me], said that, since Daughter was also GBS+, and, in her opinion, there WAS a leak, and had been for 3 days, the correct option was a C/S, as Daughter was at term but the cervix was unfavorable. Done. Antibiotics at the time of the C/S.
Just celebrated Purim. Older sister Shir dressed as Snow White, and Ilan, now 8 months, was a dwarf [we called him “Toothy” since he’s cut 8 teeth in 4 months].
Would Ilan have been OK without all the fuss? Probably. But who wanted to take the chance?
My guess is nobody looked at “Toothy” and wondered if he would have been cuter had he been delivered after a TOLAC, but I’m fairly certain his Grandma is grateful he arrived healthy and in the safest mode for him. I love toothy baby grins.
Hear, hear. I found this blog when I was newly pregnant after watching The Business of Being Born. As a scientist I really struggled to believe that medicine was letting us down, but everything on the internet seemed to concur with what it said — except Dr. A. This is such important work that you are doing. Thank you for continuing to do it.
Amen!
As far as I and I think most others are concerned, the goals in childbirth are
Keep everyone alive.
Keep everyone healthy.
Have a good experience.
In that order.
These HB people seemed to have flipped those priorities upside down. Are they clueless and don’t realize the inherent risks involved in childbirth? Or, as I suspect, do they believe that criterion 3 is worth their lives and the lives of their children?
My problem is that they all blend together and I have to go back and check if THAT shoulder dystocia birth had the baby that failed to be revived or did revive but was taken off support days later. Did that birth mother request a transfer and was denied multiple times – or was that the transfer to the hospital twice as far away? Was that loss mother the one that the midwife refused to talk to – or was that the one the midwife came to talk to about what really happened at the birth?
Then there are the “midwife said the baby was fine, that was normal for newborn” stories where the baby is born alive, develops problems and the parents listen to the midwife instead of going to a hospital.
Oh, I can’t forget the women with apparent pre-eclampsia/gestational diabetes who had midwives attempt to treat them instead of transferring them.
Correction:
“probability”
“it’s just simple probably whether they will happen to you.”
Thanks.