Lay midwife - baby's death - page 5

If the couple had insisted on using a certified nurse midwife, this would not have happened: A midwife present during the delivery of a newborn who died in a Town of Vernon home last month is... Read More

  1. by   momx3boys1girl
    Quote from Q.
    However being that the case seems to strongly suggest shoulder dystocia, the outcome would have had a chance at being positive at a hospital since the liklihood of a practitioner skilled in shoulder dystocias present would have been much higher.
    This midwife is one of the most skilled people with a SD that I know!!!! I have seen her in action and I know a local doctor who credits this woman with saving the life of one of her paitients baby (while birthing in the hospital).
  2. by   Q.
    That may be true, but I've never seen a positive outcome from a shoulder dystocia from just one caregiver. In my experience it's a true team effort to get that baby out alive. No one ever does, or should do it alone.
  3. by   momx3boys1girl
    Quote from Q.
    Not true. I've seen babies crowning and pushed back in for emergency c-section at least 4 times in my career. All those babies survived and thrived.
    We are not talking crowning here! In order for a SD to happen the entire head has to be born. Then the shoulders get stuck. Once the whole head is born you can't push it back in. The baby, if able, will have already tried to take a breath when it's face hits the air. I don't know of any hospital in our area that could have the baby out in less than 30 minutes.
  4. by   momx3boys1girl
    Quote from Q.
    That may be true, but I've never seen a positive outcome from a shoulder dystocia from just one caregiver. In my experience it's a true team effort to get that baby out alive. No one ever does, or should do it alone.
    She wasn't alone. The paper said she had 2 other women with her.
  5. by   fergus51
    Am I the only person who doubts it would have even gone that far in the hospital? The reason we see so few dystocias nowadays is partly because we intervene earlier.

    These parts concerned me more than anything though:

    "Six times in the hours that followed, the midwife performed an episiotomy using scissors, a procedure aimed at widening the birth canal."

    "the midwife told a member of the ambulance crew that the baby's head emerged from the birthing canal about 20 minutes before help was summoned"

    "She warned them, however, "that if anything tragic" occurred, she would not go to the hospital with them and they were not to use her name. She added that in such circumstances, "she would be taking the tape."

    None of these are particularly reassuring to me.
  6. by   Q.
    Quote from momx3boys1girl
    We are not talking crowning here! In order for a SD to happen the entire head has to be born. Then the shoulders get stuck. Once the whole head is born you can't push it back in. The baby, if able, will have already tried to take a breath when it's face hits the air. I don't know of any hospital in our area that could have the baby out in less than 30 minutes.
    You're in Wisconsin and you sound quite local. I know of several hospitals that have gotten true shoulder dystocias out and out alive. And that is assuming this case WAS a shoulder dystocia. Who knows? There are many possibilities: cervical entrapment, to name one.

    In my career I've never seen a shoulder dystocia get so bad that the infant died.
  7. by   Jolie
    Quote from momx3boys1girl
    She wasn't alone. The paper said she had 2 other women with her.

    I don't believe the article indicated that these other women were nurses or midwives. If they were to be of assistance in an emergent delivery, they needed to have specialized training. Q. is absolutely correct that the successful resolution of a shoulder dystocia is a team effort, requiring seamless performance on the part of the mother, her physician, midwife, nurse, and others as well, such as anesthesia, NICU, RT, etc. This is why L&D and NICU staff members rehearse emergency situations such as shoulder dystocia, prolapsed cord, precipitous deliveries, and neonatal codes. There is no time to hesitate when these skills are needed. And an untrained lay person can not perform these life-saving measures.
    Last edit by Jolie on Dec 15, '05
  8. by   Q.
    Quote from fergus51
    Am I the only person who doubts it would have even gone that far in the hospital? The reason we see so few dystocias nowadays is partly because we intervene earlier.

    These parts concerned me more than anything though:

    "Six times in the hours that followed, the midwife performed an episiotomy using scissors, a procedure aimed at widening the birth canal."

    "the midwife told a member of the ambulance crew that the baby's head emerged from the birthing canal about 20 minutes before help was summoned"

    "She warned them, however, "that if anything tragic" occurred, she would not go to the hospital with them and they were not to use her name. She added that in such circumstances, "she would be taking the tape."

    None of these are particularly reassuring to me.
    No, you're not the only person. And those 3 things concern me as well. Regardless of what happens, I don't see why ANY midwife, lay or otherwise who is supposedly acting as a professional would not accompany her patient to the hospital and willingly take accountability for the outcome, ESPECIALLY if she thinks she did everything she could.

    When bad outcomes have happened with my patients, I am the first to step up and say exactly what I did to help prevent the tragedy: I have nothing to hide as I KNOW I did my best and what best practice is.
  9. by   dhall4
    Quote from fergus51
    Am I the only person who doubts it would have even gone that far in the hospital? The reason we see so few dystocias nowadays is partly because we intervene earlier.

    These parts concerned me more than anything though:

    "Six times in the hours that followed, the midwife performed an episiotomy using scissors, a procedure aimed at widening the birth canal."

    "the midwife told a member of the ambulance crew that the baby's head emerged from the birthing canal about 20 minutes before help was summoned"

    "She warned them, however, "that if anything tragic" occurred, she would not go to the hospital with them and they were not to use her name. She added that in such circumstances, "she would be taking the tape."

    None of these are particularly reassuring to me.
    Do you know that any of this was really said, or truly occurred?? Please remember that the media likes to distort the truth, shocking things get more attention then a bland story!! In regards to video taping a birth...I know plenty of Dr's who do not even allow you to consider taping your own birth for fear of being sued ~ a friend of mine was told that they could not even take PHOTOS of the birth!! Not a single picture was allowed at the hospital birth until the cord was cut.

    How can you predict which baby will have SD? A large baby, a small baby?? they told me that my son would have a problem (because they suspected a large baby) & he came flying out & was over 9#.

    We also do not know the true reason this baby died.....it is all specualtion right now ~ last I read they were still trying to determine the cause.
  10. by   dhall4
    Quote from mstigerlily
    No, no one can "promise" a positive outcomes. Doctors are not Gods. They do what they can. Yes, some babies will die anyway. But I do know that OUR hospital's policy is "15 minutes from decision to incision" we have a dedicated OR suite right next to L&D and anesthesiologists and surgeons on site 24/7/365. NO ONE waits an hour for an emergency section. We have a LII nursery next to the OR and LIII nursery 10 minutes away. ALS nurses are standing by in the room of ALL high risk births and ALL c-section births.
    How wonderful that your hospital has that policy!! That is great to know that if the need arises there is the staff already there & waiting ~ not all hospitals have this. A dear friend of mine had a vbac & was very limited in her choices because of it.....she ended up birthing someplace that she did not really want to be because the other hospital not have the capability to handle a true emergency c-section.
  11. by   momx3boys1girl
    Quote from fergus51
    Am I the only person who doubts it would have even gone that far in the hospital? The reason we see so few dystocias nowadays is partly because we intervene earlier.

    These parts concerned me more than anything though:

    "Six times in the hours that followed, the midwife performed an episiotomy using scissors, a procedure aimed at widening the birth canal."

    "the midwife told a member of the ambulance crew that the baby's head emerged from the birthing canal about 20 minutes before help was summoned"

    "She warned them, however, "that if anything tragic" occurred, she would not go to the hospital with them and they were not to use her name. She added that in such circumstances, "she would be taking the tape."

    None of these are particularly reassuring to me.
    What interventions would you do for a dystocia? When? How could you do them earlier than when a dystocia is occuring? And it is not like we see them all that often at home either, but they do happen.

    The quotes you posted are inacurate! The newspaper did a horrible job of reporting!
    Who would cut 6 episiotomies? And over a few hours??? What do you think that the midwife just sat around and thought gee she is 7 cm maybe I should go a head and cut an episiotomy now and maybe again when she is 8 cm and then again a few hours later?? That is just a reporter who has not idea about birth!

    The midwife did not tell the ambulance crew that, someone else did. Maybe they ment it had been 20 minutes since they started to see the baby's head through the labia, we don't know. If that were the case that is not anything unusual.

    If this midiwfe was so worried about being found out about do you think she would have hung around once the ambulance was called? Or as the newpaper reports gave the mom a shot of pitocin in front of the EMT. I know this midwife has transported clients to the hospital before and she goes with them. She has never hidden who she is or what she does.
  12. by   momx3boys1girl
    Quote from Jolie
    I don't believe the article indicated that these other women were nurses or midwives. If they were to be of assistance in an emergent delivery, they needed to have specialized training. Q. is absolutely correct that the successful resolution of a shoulder dystocia is a team effort, requiring seamless performance on the part of the mother, her physician, midwife, nurse, and others as well, such as anesthesia, NICU, RT, etc. This is why L&D and NICU staff members rehearse emergency situations such as shoulder dystocia, prolapsed cord, precipitous deliveries, and neonatal codes. There is no time to hesitate when these skills are needed. And an untrained lay person can not perform these life-saving measures.
    Both of these women were very exprienced birth attendants.
  13. by   Q.
    Quote from momx3boys1girl
    The quotes you posted are inacurate! The newspaper did a horrible job of reporting!
    And you know this how exactly?

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