Home births gone wrong

[MNNICU, RN]

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!

[momof3lv]

I don't think she has to be outside of midwifery care but....she's not getting a home birth! She may very well get a midwife in a hospital setting with great MD coverage but that's it. There's no way. I don't think you have to really approach it. I would give her names and they will handle it. You could also easily tell her that you aren't sure they will take her but maybe hey will and maybe they will consider her for a hospital birth. Not your responsibility to deny the care...let the midwife do it.

Grated there may be different parameters for different midwives but I was a healthy person with well controlled bp on meds and the midwife at my doctors office wouldn't take me on just due to that. I can't see any taking on a very advanced maternal age patient with serious heart issues.

[whisperingsage]

I have to weird about vitamins again, sorry folks.... My goats taught me this AND Pat Coleby taught me this- potasium deficiency will cause otherwise normally experienced and good moms to need to have their babies "pulled" (in the sheep and goat world and cattle also) you must put the hand and arm in and reposition the baby), needless to say there are risks of contamination and infection. But it can be a lifesaver in an emergency. But since MAKING certain my animal mothers have adequate potassium throughout the pregnancy, I have not had to "pull" a baby for the last few years and I am thrilled. Even smallish first timers (accidental- bucks broke in) pop babies right out. This would be something for birth educators to consider in humans. It's really amazing how well it works. Also for Moms that tend to ave toxemia, besides routine magnesium supplementation, real folate, metylcobalaamin, MSM and trimethylglycine would be very helpful.

[ana.saavedra14]

I guess parents want to experience the old ages when women would give birth at home.

There was once this couple who were very holistic, they were both chiropractors. Mom never had any ultrasound, labs drawn, anything until it was time to deliver the baby at home.. Well she was past 40 weeks and wasn't going into labor. Thankfully the midwife nurse saw this as a red flag and decided to do an ultrasound... baby had CDH ended up passing away. They still said if they were to have another baby, they would do the same (meaning no ultrasounds).

It's so hard not to judge because it is their decision... but that's why there is technology now, to find out what can be wrong with a baby and plan ahead of time!

[IrishIzCPNP, MSN, RN, APRN, NP]

I guess parents want to experience the old ages when women would give birth at home.

There was once this couple who were very holistic, they were both chiropractors. Mom never had any ultrasound, labs drawn, anything until it was time to deliver the baby at home.. Well she was past 40 weeks and wasn't going into labor. Thankfully the midwife nurse saw this as a red flag and decided to do an ultrasound... baby had CDH ended up passing away. They still said if they were to have another baby, they would do the same (meaning no ultrasounds).

It's so hard not to judge because it is their decision... but that's why there is technology now, to find out what can be wrong with a baby and plan ahead of time!

And the outcome would have been different had they known? Maybe not. Interventions also lead to issues and complications...but we try not to talk about that.

[Maevish, ASN, RN]

Klone, I always enjoy your posts and respect your expertise so much. Home births just scare the crap outta me! I have no doubt that statistically, my experiences weren't significant. Mentally though, those experiences left a mark for me personally.

I mean, I know that women safely deliver at home every day - I've even been there. My guess is that having appropriate education, screening and advice before undertaking a home birth is critical. I'm sure there are safer ways to undertake this endeavor. I just know for me personally, if I was still bearing children, I would be terrified. That, and I'm the equivalent of a white-knuckle back seat driver when any of my loved ones go this route: All I can do is keep my hands firmly on the oh **** grip and my mouth shut! But then, these biases are why I don't work in that specialty.

Sincere apologies if I was in any way offensive.

I'm hoping maybe she read it wrong or something because I totally get it. I don't yet work in the NICU, but I have friends who do and express the same frustrations. It's just so much harder because it's a baby. When I have an adult pass away, sure, it's sad in some cases simply because they're young or the cancer moved quickly, but usually it's a good thing because they're no longer in pain and suffering.

When it's a baby, I think that's what makes it harder for nearly everyone to deal with and it's also one of the most personal decisions, as a mother, you'll ever make.

That being said, I have friends who have been hell bent on home births and with good reason a)because they wanted to and b)there were no risk factors in play. Most of them, however, had a plan in case something did go wrong and used nurse midwifes instead of lay midwives (I'm sure there are good ones out there, but I've not experienced a good lay midwife).

My feeling on it is that you don't get a medal for it so why put your baby (and yourself) in danger if you have medical issues/develop HELLP that would make a hospital birth prudent? That's the only reason I would ever broach the "selfish" word.

There are some hospitals who will let women come and have minimal monitoring during labor and you can still have the midwife (who is usually a complete rockstar!), but you're there in case something goes wrong. I know that's not available everywhere, though.

This thread has been helpful to me because that's the only reason I didn't go into that right after school because I had an offer from a NICU before I graduated. I didn't take it because of this aspect (and babies dying in general is a sucky thing to think about), but as a seasoned nurse I feel I may (MAY) be able to handle it better mentally.

Thanks for the info and sharing!

xo

[Maevish, ASN, RN]

I think women would feel more comfortable delivering in hospitals if physicians and nurses were more open and compassionate regarding their birth plans. I am absolutely not saying that any nurse who's posted here is non compassionate but I can tell you from my personal experience delivering my 2 children and being a L&D nurse for 2.5 years, a lot of doctor and nurses are real jerks to women who wish to pursue natural options. I heard so many nasty comments regarding women who come in with a simple birth plan and the nurses say "oh she'll be having her c-section before the shift is over". Yes modern medicine is wonderful. Yes women need to make educated decisions and yes, I feel a hospital is safer than home. However I've seen all too well that women are just flat out not respected in hospitals. The plan is get them in, get the baby out as quick as possible and get them out. Starting pitocin when it's not necessary, scaring moms into getting sections. If a mom wants to have a natural birth, have a doula, sit on a birthing ball, play music, whatever, she shouldn't feel chastised. And unfortunately that's all too common place now. While I agree with you regarding hospitals being safest, some attitudes sicken me. Again, not the OP or any others that have replied.

AGREED!! I did clinicals at a Catholic hospital (in my OB rotation) and I was appalled by how openly they shamed mothers who didn't want to or COULDN'T breastfeed their babies. I specifically remember a poor lady who literally couldn't breastfeed, made worse by the fact that she was dying to be able to, with skin breakdown on her nipples/breasts because she was trying so hard to do it. The staff at those types of places could make more of an effort to adapt to people and their choices and that might help a lot.

xo

[Maevish, ASN, RN]

I want to revive this thread to get your input. There is a gal at work with whom I'm friendly. We are both counterculture on health management, as I mentioned earler, I had my children at home. I'm not extremist, but grew up in a very healthy conscious home, avoid processed foods, get exercise, and generally distrust the medical establishment, etc.

She texted me about midwife references a couple of weeks ago, I asked around and gave her some. It turns out, she is the pregnant one! The thing of it is, she's 57 yrs old. She has 5 grown kids, is raising a couple of grandkids, and is in a relatively new marriage.

Now, I'll mention, this gal is someone I admire, for her stamina, energy, positivity, commitment to health etc. She appears the picture of health, but has had cardiac problems, has a pacemaker, I think she had a valve replacement, did a lot of self healing she told me. She looks 40. She's planning a homebirth I've heard.

How can I effectively approach her?

Wow...I second the people saying that no way should she not be under the care of an OB/ultra qualified nurse midwife for this delivery. My friend is 33 (and has a pacemaker) and while the doctor didn't discourage her desire for a baby, he made it clear that it would most likely end up being a c/s because of the stress of labor on an already compromised heart.

With this woman and her advanced age (childbirth-wise speaking), she should definitely be monitored in hospital because it's way more likely that something would happen to her versus my much younger friend. The pacemaker alone should make that automatic, I should think.

Good luck to her too! How exciting to be starting that adventure all over again at that age!

xo

[cayenne06, MSN, CNM]

The reality is that home birth is not integrated into the medical system in the US, and that does, indeed, increase the risk. Even for healthy, low risk mothers. I had my kids at home, and practiced as a home birth midwife for years. If we want to mirror the safety of, say, UK homebirth, then we need to incorporate it into the health care system so women who desire this option are afforded the safest, most timely access to emergency care. Even more importantly, we need to do something about the CPM credential- The CPM credential does not meet the standards set by the ICM, and the quality of training can vary from rigorous and comprehensive to shockingly inadequate. There are great CPMs, but the credential itself in no way guarantees entry level competency as defined by the consensus of the international midwifery community. Pseudoscience is rampant in the CPM profession, as is distrust of mainstream medicine. I can give endless examples from my time as a practicing CPM. I know of too many rogue direct entry midwives who feel they are qualified to, say deliver twins or breech babies at home. The very fact that they feel a home birth is appropriate in these situations speaks to their judgment.

I started my midwifery career as a CPM and still hold the credential. But until we shore up the entry level requirements, we will be exposing women to substandard midwives who believe they are fully competent, and advertise themselves as such.

I always wonder after reading the comments "I was low risk and healthy but my baby and/or I would have died if we weren't in a hospital" what interventions did you allow that caused these severe complications?

Wow, that is an inflammatory statement. There are major problems within the practice of obstetrics in this country, but the onus is NOT on the patient to vet each and every intervention that is recommended. It is not the patient's fault for not refusing care, if iatrogenic harm results.

Of course it is a good idea for patients to be informed, but no amount of "research" equals the training and expertise of a qualified midwife or OB. Patients deserve to be able to trust their provider's judgment, and the burden of responsibility for iatrogenic harm is 100% on US, never on the patient.

I mean, good lord. Imagine if you made the same comment towards am 80yo guy who had a prostatectomy, recommended by his physician, due to indolent cancer that was found after routine PSA was elevated. Is it the patient's fault for not knowing that he will almost certainly die of unrelated causes before the cancer even begins to be a potential cause for concern? Is he responsible for knowing which screening tests to accept and refuse?

Also, there is a common fallacy that childbirth is safe for low risk, healthy women. In fact, even the most straighforward birth carries risk that is far greater than almost any other experience a woman will go through in her life, excepting of course her own day of birth. Perinatal and maternal death was commonplace prior to modern medicine, and the drop in M&M cannot be attributed to hygeine and nutrition alone. Evolution doesn't really care how many children and women die in childbirth, as long as the net result is gene propagation and population increase.

[izzymommy]

Speaking to those saying that midwives carry resuscitation equipment; just a bulb syringe or even a canister of O2 is not enough. If they are not NRP certified they are not qualified to be resuscitating an infant and will not be doing it most effectively. They certainly aren't going to be able to intubate which is necessary in some scenarios and they aren't going to be able to start a line for fluids. I can't tell you how many YouTube videos I've seen where the baby clearly needed some form of resuscitation. Midwife was torn between helping mom or helping baby. Ineffective bagging with no chest movement, blow-by O2 being given by nasal cannula when baby was clearly blue and not breathing - these are not the "professionals" I want resuscitating my baby if/when he needs help. And according to NRP guidelines 10% of babies WILL need help breathing at birth. Proximity to the hospital does not appease me either; you try going without oxygen for even 5 minutes, it's not going to be a good outcome!

[cayenne06, MSN, CNM]

Yes, it is criminal and morally WRONG to attend a home birth without the appropriate training, supplies, and support staff. I know plenty of home birth midwives who practice solo, without even an assistant (unless they have a student in tow).

Women deserve to be able to trust that a midwife is educated and prepared to the consensus standard. The CPM credential is inadequate, and I am annoyed as heck about it. Women deserve safe, science-based maternity care in the birthing locale of their choice.

[izzymommy]

Is a CNM even certified in NRP?

[lavenderskies, BSN]

Is a CNM even certified in NRP?

I know many highly educated, knowledgeable CPM. Yes they have chosen to be NRP prepared.

Same with CNM. I don't know that either are mandated, but all I know are.