Home births gone wrong

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Specializes in NICU.

Do you see this often in your facility? In 2.5 years we have had 2 babies die and 2 be severely disabled from home birth. I have a really hard time with this. I understand my role is to care for babies and families without judgement to the best of my ability (which I DO!) but I come home and just stew on these situations. Recently we had a mom who was told she needed a C section by two different physicians at two different facilities for a breech baby and low fluid and she refused, signed out AMA and attempted a home birth with midwives. The baby of course became stuck with the body born and required a 13 minute code. We cooled her immediately for 72 hours and she spent two weeks on a vent. She just now is extubated but will require a trach because she can't cough or swallow or gag so secretions just build up. She is more or less vegetative and on a slew of anti seizure meds. This stuff just really makes it hard for me to sleep! I feel like these poor innocent babies end up paying for their parents risky stupid decisions. Does anyone else see these situations? How do you handle it? I am not looking to hear about how my job isn't to judge, I get that. But I am human too and this job is very emotional sometimes!

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Specializes in Pediatrics, High-Risk L&D, Antepartum, L.

That isn't really a home birth gone wrong. That is a case of poor decision making. Safe home births are exactly that...safe and usually safer than in the hospital. If a mom makes a poor choice against medical advice it doesn't mean that choice is wrong for everyone.

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Specializes in NICU.

Maybe we just have bad luck in this area? 1 of the deaths and 1 of the babies that ended up severely disabled were considered "low risk". Moms with no prior medical history, baby in the right position, healthy pregnancy... in both of those cases things went wrong really fast with cord complications and they transferred right away but with no oxygen those babies didn't last long. I am in the US where homebirth infant mortality is 4 times higher than in hospital births so it tends to be a bit of a sore subject amongst our coworkers because we see a lot of issues with it. Maybe just our experience?

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Specializes in Pediatrics, High-Risk L&D, Antepartum, L.
Maybe we just have bad luck in this area? 1 of the deaths and 1 of the babies that ended up severely disabled were considered "low risk". Moms with no prior medical history, baby in the right position, healthy pregnancy... in both of those cases things went wrong really fast with cord complications and they transferred right away but with no oxygen those babies didn't last long. I am in the US where homebirth infant mortality is 4 times higher than in hospital births so it tends to be a bit of a sore subject amongst our coworkers because we see a lot of issues with it. Maybe just our experience?

Where is your stat that infant mortality is 4 times higher? I have never seen a reputable statistic that is that high.

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Specializes in NICU.

Study Ties Home Births to Higher Infant Death Rates – WebMD

This was from a CDC study

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Specializes in Pediatrics, NICU.

Yes! There is a group of midwives in my area that deliver at home and at their birthing center that we see come in with their patients quite often. One of their patients was a similar story to yours. The baby was known to be frank breech a couple days before delivery but the midwives allowed mom to labor at home. Baby got stuck, was coded and died anyway (the baby was essentially dead when mom arrived at the hospital). Beautiful perfect baby who I'm convinced would still be alive if mom got a C-section. Overheard the midwife tell the parents that the baby obviously wasn't meant to live. :mad:

We also had another baby that they removed from the birthing pool too slowly and the kid was an aspiration pneumonia/PPHN/whole body cooling.

Then there was baby that the midwife dropped on the bathroom floor and fractured the baby's skull but didn't bring him in until he started seizing. (Granted, anyone can drop a baby but the delay in seeking treatment shows poor judgement. And I despise this particular midwife)

I get extremely upset as well with seeing these poor outcomes. It's just frustrating because it feels so preventable.

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Specializes in medical, peds, telemetry, school nursing.

Are these midwives nurse midwives or lay midwives?

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Specializes in NICU.

I am glad I am not the only one who feels this way. I understand the want for a natural birth, totally. Our hospital offers "low intervention" pathways with certified nurse midwives and it works out beautifully. Moms don't even have to have an IV if they are GBS - and everything is going accordingly. We have jet tubs for labor (although don't allow water birth) that even I used during my labor with my son. They really actually push for low intervention and the doc was kind of disappointed when I asked for my epidural at 7 cm. They are trying to take a very natural approach. Our C section rate is higher because it's a high risk OB center. But totally natural deliveries can be achieved at hospitals if it's desires and you fit the criteria. I just don't understand how these babies just keep being injured and dying and no one is doing anything about it! We had one mom that was GBS positive and the local birthing center in town told her to shove a garlic clove up her hooha to kill the bacteria and the kid went into RDS about 4 hours after birth. The midwife told them just to drive the kid to the ER and when they got there the baby was sating in the 40's and HR about 90. Totally blue and limp. GBS sepsis. When we were down in the ER trying to resuscitate the kid the mom asked me "when can I put him to breast again?". I wanted to slap her. Then we went to get an emergency line into place and the parents tried to decline antibiotics because their midwife told them antibiotics were terrible for babies and not necessary. He ended up on HFOV maxed out on dopamine and dobutamine within an inch of death. Thankfully he lived. But I just don't understand why this stuff happens

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Specializes in NICU.

for us mostly lay midwives which is where the problem lies. They aren't policed and have very little authority to report to. We have caught them forging and changing records or lying straight to us. All of the nurse midwives we encounter work for our health care system and are WONDERFUL.They deliver in hospital settings and are great. Never one issue with them

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Specializes in Pediatrics, NICU.
We had one mom that was GBS positive and the local birthing center in town told her to shove a garlic clove up her hooha to kill the bacteria and the kid went into RDS about 4 hours after birth. The midwife told them just to drive the kid to the ER and when they got there the baby was sating in the 40's and HR about 90. Totally blue and limp. GBS sepsis. When we were down in the ER trying to resuscitate the kid the mom asked me "when can I put him to breast again?". I wanted to slap her. Then we went to get an emergency line into place and the parents tried to decline antibiotics because their midwife told them antibiotics were terrible for babies and not necessary. He ended up on HFOV maxed out on dopamine and dobutamine within an inch of death. Thankfully he lived. But I just don't understand why this stuff happens

Sometimes the parents are so determined not to do anything unnatural and it can be so frustrating when their baby is so sick. We had one baby admitted from home with GBS sepsis and the parents tried to refuse antibiotics based on the advice of their midwife. We needed a court order and the parents griped for their whole stay about how we were "poisoning" their child. Never mind that the kid came in DIC and needed to be vented for several days because of sepsis.

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Specializes in ER, Med-Surg/Telemetry.
Sometimes the parents are so determined not to do anything unnatural and it can be so frustrating when their baby is so sick. We had one baby admitted from home with GBS sepsis and the parents tried to refuse antibiotics based on the advice of their midwife. We needed a court order and the parents griped for their whole stay about how we were "poisoning" their child. Never mind that the kid came in DIC and needed to be vented for several days because of sepsis.

I have great admiration for NICU nurses. It must be infuriating to have to deal with parents who put their babies in those situations.

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Specializes in retired LTC.

Have you and your peers sought counseling with EAP at your place? Sounds like it's needed.

Hugs for you guys there - not someplace I every wanted to work, prob because of situations like that.

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