Australian Home Birth Advocate Dies After Childbirth

Elvish, BSN, DNP, RN, NP · Feb 2, 2012

What do I think? In all seriousness, I think I want to know more.

Did she fall into any high-risk category other than age*? Did her midwives suggest a hospital transport at any point?

I wonder if it was something like an amniotic fluid embolism, that can't be predicted nor prevented, and would almost certainly have killed her no matter where she delivered. It is fortunate that AFEs are very very rare, because they are also very very ugly. I would be very interested in seeing the coroner report when/if it becomes available.

*ETA - which, at 36, is not really in itself 'high-risk' for a birthing situation, only for possible fetal anomalies.

If as the midwifery organization suggested, this is the first maternal homebirther death in 15 years, their numbers are better than the place where I work. There is enough evidence to suggest that home birth is at least as safe as, if not safer than, hospital birth for low-risk women in the hands of skilled attendants.

beachmom · Feb 4, 2012

So if a woman dies in the hospital, would we be talking about banning hospital births???

One bad outcome at home really should not open up any debate. Giving birth has risks, wherever it happens

eden · Feb 4, 2012

I think home birth is a fine choice, given the proper circumstances. If a woman is well informed and chooses this route, I think homebirths ( with a certified midwife in attendance, don't get me started on intentional unassisted home births) can be great but they aren't for everyone. Personally I would never give birth other then at a hospital because that is where I am comfortable.

I think it is very sad that she died but I would truthfully need to know more about her specific case to know whether or not homebirth was a good idea for this particular woman. I also think because she was a home birth advocate this is going to give rise to debate.

Jolie, BSN · Feb 4, 2012

I think the same as I thought prior to reading the article. Women (couples)should be free to choose the location and circumstances of childbirth.

We don't legislate a standard course of "treatment" for any other health condition, and it is wrong to do so for childbirth.

Home, birth centers and hospitals all have their advantages and disadvantages. My only concern regarding an individual's choice in childbirth care is that the provider they utilize is duly licensed to practice in that location.

In my experience, it is not so much the setting which poses a danger to mother and baby, it is the actions/inexperience/poor judgement of unlicensed providers.

melmarie23, MSN, RN · Feb 7, 2012

She died the day after delivery and of cardiac arrest, and in the hospital (where she was transferred after giving birth. IMO, its unfair to link her home birth to her death. This same situation could have very well have happened had she given birth in the hospital.

TeenyTinyBabyRN, BSN, RN · Feb 13, 2012

From a NICU perspective, home births freak me out. When we hear a baby is coming in from a home birth, we all get ready for a train wreck. These admits are almost never pretty. We see severe MAS and PPHNers. We had a baby with apgars of 9, 5, 0. Full blown PPHN. Midwife gave epi, EMS tried to intubated, but couldn't, so they bag mask PPVed the kid the whole 2 hours it took them to get to the hospital. He died shortly after being admitted. Many things can go wrong in the hospital, but at least you have a doc/NNP in house, with all the meds and supplies you need. I may be judgemental, because I only see the bad cases... healthy babies don't need to go to NICU... but the bad cases are really bad, and there have been a lot of mortality/mobidity that could have be avoided, IMO.

Elvish, BSN, DNP, RN, NP · Feb 13, 2012

From a NICU perspective, home births freak me out. When we hear a baby is coming in from a home birth, we all get ready for a train wreck. These admits are almost never pretty. We see severe MAS and PPHNers. We had a baby with apgars of 9, 5, 0. Full blown PPHN. Midwife gave epi, EMS tried to intubated, but couldn't, so they bag mask PPVed the kid the whole 2 hours it took them to get to the hospital. He died shortly after being admitted. Many things can go wrong in the hospital, but at least you have a doc/NNP in house, with all the meds and supplies you need. I may be judgemental, because I only see the bad cases... healthy babies don't need to go to NICU... but the bad cases are really bad, and there have been a lot of mortality/mobidity that could have be avoided, IMO.

We see bad maternal cases, too, the bad maternal HB transfers. But people die in hospitals, too, and I have seen bad things happen to moms and babies that wouldn't have happened (or wouldn't have been as severe) had they birthed at home. Believe me, I understand the bias that comes with seeing the worst case scenario, but strictly speaking in numbers, the evidence supports low-risk women (and their babies) delivering at home safely.

I would still be interested in seeing the autopsy report to see what, if anything, triggered the cardiac arrest (I mean, technically, isn't that what everybody dies from?).

beachyfe · Feb 27, 2012

I think the same as I thought prior to reading the article. Women (couples)should be free to choose the location and circumstances of childbirth.
We don't legislate a standard course of "treatment" for any other health condition, and it is wrong to do so for childbirth.
Home, birth centers and hospitals all have their advantages and disadvantages. My only concern regarding an individual's choice in childbirth care is that the provider they utilize is duly licensed to practice in that location.
In my experience, it is not so much the setting which poses a danger to mother and baby, it is the actions/inexperience/poor judgement of unlicensed providers.

I totally agree. Each place has it's benefits and risks. Every case is different and should be evaluated for where is the safest place to deliver. Some midwives (lay or CNM) are better than others. I had 3 fantastic home births with lay midwives and 1 horrible hospital birth with a doctor, but also worked 16 yrs in L&D with CMN's and docs. I've seen alot, and the qualifications of the attendant makes a huge difference.

ktliz · Mar 2, 2012

they bag mask PPVed the kid the whole 2 hours it took them to get to the hospital.

Two hours to get to the hospital? That's a problem right there.

:twocents: : Of course there is morbidity & mortality that may have been avoided in the hospital instead of the home. However, the reverse is also true.... unnecessary intervention practiced by some docs (and even some midwives) in the hospital can lead to morbidity and mortality as well. The risks of childbirth skyrocket when lady partsl birth is compared to C/S, and I think most can agree that there are plenty of unnecessary sections going on these days.

It all comes down to risk management, which is a somewhat subjective calculation. There are clear-cut cases in both directions (very high-risk pregnancies vs. low-risk professionally attended home births within a few minutes of the hospital) but there are also cases where all we can do is inform people of the pros and cons and let them decide what is best for themselves.