Home births gone wrong

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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!

It is still not within their scope of practice to intubate or place umbilical lines. Those are services only immediately available at a hospital. Without an ETT/epi/volume expanders, you are not performing NRP - it includes way more than just CPR. Simply taking an NRP class does not mean you are competent/qualified to resuscitate. It takes repetition and training with an experienced team to become confident in performing effective NRP. There is NO replacement for immediate, skilled resuscitation, precious minutes that can never be returned.

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Specializes in Reproductive & Public Health.
Is a CNM even certified in NRP?

Those of us who work in LDRP are. I was also certified in NRP as a CPM. But being certified every 2 years is pretty meaningless when you almost never have to use those skills. CPMs generally only do a handful of births a months, and these are all (hopefully) low risk women with full term, singleton pregnancies. Thus you could easily go years and years without coming across a seriously compromised newborn. The competent HB midwives I know are well aware of this fact and take measures to keep their skills fresh (quarterly drills etc). But too many are simply happy to "trust birth." The reality is, birth goes well most of the time, even in higher risk women. So it is easy to get a false sense of security.

And there is a heavy reliance on pseudoscientific "medicine" ingrained in the profession- in my experience the majority of CPMs subscribed to potentially dangerous pre-scientific ideas, like substituting pitocin for shepherd's purse tincture or recommending homeopathic pulsatilla instead of antibiotics for mastitis, or presenting a clear bias against immunizations. These are things I was taught in CPM school and perpetuated to my patients, before I figured out how profoundly wrong I was.

ETA- Have you guys heard of the old magazine called "Mothering?" The one that featured a cover picture of HIV-denialist Christine Maggiore? The woman who refused AZT in pregnancy, refused HIV testing of her children, and watched her daughter die of AIDs related complications as a toddler (and called it allergic anaphylaxis to an antibiotic), and then passed away herself from AIDs related complications? I used to use that magazine as educational material for my patients.

If you want to know the true state of the type of care embraced by direct-entry midwifery, check out their "academic" journal called Midwifery Today.

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Specializes in Reproductive & Public Health.

Just saw this article-"Why is American Home Birth so Dangerous? http://www.nytimes.com/2016/05/01/opinion/sunday/why-is-american-home-birth-so-dangerous.html?_r=0

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Specializes in Family practice, emergency.

Ugh ^^ that article is by Amy Tuteur, queen of "an OB has to attend the birth for it to be safe." Although this article is toned down from her normal and does address that CNMs are often better prepared than direct entry midwives, she is such a fear mongerer I just can't take her seriously. She makes my teeth start grinding on autopilot.

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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

What does the fact that it was a Catholic hospital have to do with it? Catholics don't take a position on breast feeding one way or another.

I work at a secular hospital and the militant breast feeders here are unbelievable. Some of them even discourage labor epidurals because of some imaginary link to problems with breast feeding.

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Specializes in Reproductive & Public Health.
Ugh ^^ that article is by Amy Tuteur, queen of "an OB has to attend the birth for it to be safe." Although this article is toned down from her normal and does address that CNMs are often better prepared than direct entry midwives, she is such a fear mongerer I just can't take her seriously. She makes my teeth start grinding on autopilot.

Yes yes, you are right. I didn't see her byline until I posted this. I am 100% not a fan of Dr. Amy, and hate-read her blog on a regular basis. But even a stopped clock is right twice a day, and this article is SPOT on. 100% agree with everything she wrote.

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Specializes in L&D.

Read "Why is American home birth so dangerous?" Publishes in the New York Times and found at skepticalob.com

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Specializes in Healthcare risk management and liability.

Home Birth After C-Section Tied to Serious Complications | Medpage Today Home birth after c-section tied to serious complications

I will be interested to read the journal article when it comes out, especially if a distinction is made between lay, licensed and nurse midwives in attendance at the home birth.

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It's great that you had such a conscientious and educated provider.

And, it's great to say that women should use their "critical thinking skills" to determine their own childbirth experience.

How exactly are women in the U.S. supposed to do that? There are no rules or regulations regarding home birth. In most states literally anyone can call themselves a midwife.

If someone presents themselves as educated about childbirth, or any health related issue, then most lay people are going to trust them. There are no state boards policing their actions. They don't carry malpractice insurance, so there are no lawsuits. They aren't licensed by the state, so there are no regulatory boards to report them to.

Telling women to use "critical thinking skills" is just another way to blame the victims when they are deceived by these so-called professional midwives and end up with bad outcomes.

Individuals who are uneducated in women's health are easy to deceive and manipulate, which is what these midwives depend on. A governing body of educated health professionals is not, which is why they are so resistant to mandatory licensure and adopting standards of practice.

I'm surprised that it took so long for someone to come at this situation from a legal standpoint as opposed to a personal preference from the mother.

Now I'm not a nurse so feel free to take my opinions with a grain of salt or ignore them all together as until i get put in the devastating position of you nurses, and have to watch a baby die that didn't have to die I can't really judge anyone's opinion on this.

Keep in mind tho that even though I may not be a nurse, I do have 5 children. I was diagnosed with cervical cancer after the birth of my second where the had to go in and remove my cervix to get rid of the cancer. Because of me not having a cervix the last 3 of my babies were born extremely early. Meaning I've spent my fair share of time in the NICU helping my 3 premie babies heal. I also have a sister with advanced chrons disease, and I was very involved with her care at home so I'm not a stranger to how our health care system works.

So, for anyone who may want it, this is my opinion on home births and judging mothers who choose home birth despite doctors orders not to have one.

I always fantasized about giving birth at home and how nice it would be to labor and deliver in my own home away from all the medical supplies, iv's, and monitors but due to my cancer I was considered high risk and birthing at home just wasn't an option. And for any pregnant woman who gets told point blank from a doctor that if they choose home birth both the life of her baby and her own life would be greatly at risk, and yet they choose to do it regardless, are selfish and neglectful to that baby in their belly.

Now to sit here and say all women who birth at home are neglectful and selfish is wrong. If your having a normal low risk pregnancy and choose homebirth thats thier decision and i have no room to judge. Like the poster said before me though, in this country how is it one goes about knowing if it's safe your not cause a lot of times a normal low risk pregnancy can still end in complications.

My solution to that problem and help protect the babies that didn't choose where to be born is for the government to pass a law with restrictions on who can home birth and who can't. At the very least a few innocent lives could be saved by having a law like that forcing high risk pregnancy mothers to deliver at the hospital.

I think the law should say something like it's legal and the woman has the right to choose where she gives birth with certain restrictions put in place to protect the baby. The main requirement should be that you have had to already birthed at least one child and it was a low risk natural and smooth delivery. Most of the times women's deliveries are similar where the risks are concerned at least.

That way if you've never given birth and honestly don't know how it will turn out even being low risk, home birthing is against the law for those women that way should a problem arise you'd be in a hospital to help.

I think a VBAC should not be aloud to have in your own home with no medical personal available.

This way the women can still choose to birth at home all the while the government will make sure your in good enough health to do it, maybe meaning the number of deaths brought on by homebirth each year will drop.

Forgive the long post I just wanted to put in my 2 cents. I truly believe there's a way to let mothers birth where ever they want but at the same time lower the mortality rate of babies being morn at home each year. It's not often I agree with both sides of a debate cause I'm normally firm with my beliefs but in this case I think both sides are right. A mother has the right to choose where she births but it's also neglect to go against doctors orders and home birth against thier advice.

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Specializes in Hospice.
I'm surprised that it took so long for someone to come at this situation from a legal standpoint as opposed to a personal preference from the mother.

Now I'm not a nurse so feel free to take my opinions with a grain of salt or ignore them all together as until i get put in the devastating position of you nurses, and have to watch a baby die that didn't have to die I can't really judge anyone's opinion on this.

Keep in mind tho that even though I may not be a nurse, I do have 5 children. I was diagnosed with cervical cancer after the birth of my second where the had to go in and remove my cervix to get rid of the cancer. Because of me not having a cervix the last 3 of my babies were born extremely early. Meaning I've spent my fair share of time in the NICU helping my 3 premie babies heal. I also have a sister with advanced chrons disease, and I was very involved with her care at home so I'm not a stranger to how our health care system works.

So, for anyone who may want it, this is my opinion on home births and judging mothers who choose home birth despite doctors orders not to have one.

I always fantasized about giving birth at home and how nice it would be to labor and deliver in my own home away from all the medical supplies, iv's, and monitors but due to my cancer I was considered high risk and birthing at home just wasn't an option. And for any pregnant woman who gets told point blank from a doctor that if they choose home birth both the life of her baby and her own life would be greatly at risk, and yet they choose to do it regardless, are selfish and neglectful to that baby in their belly.

Now to sit here and say all women who birth at home are neglectful and selfish is wrong. If your having a normal low risk pregnancy and choose homebirth thats thier decision and i have no room to judge. Like the poster said before me though, in this country how is it one goes about knowing if it's safe your not cause a lot of times a normal low risk pregnancy can still end in complications.

My solution to that problem and help protect the babies that didn't choose where to be born is for the government to pass a law with restrictions on who can home birth and who can't. At the very least a few innocent lives could be saved by having a law like that forcing high risk pregnancy mothers to deliver at the hospital.

I think the law should say something like it's legal and the woman has the right to choose where she gives birth with certain restrictions put in place to protect the baby. The main requirement should be that you have had to already birthed at least one child and it was a low risk natural and smooth delivery. Most of the times women's deliveries are similar where the risks are concerned at least.

That way if you've never given birth and honestly don't know how it will turn out even being low risk, home birthing is against the law for those women that way should a problem arise you'd be in a hospital to help.

I think a VBAC should not be aloud to have in your own home with no medical personal available.

This way the women can still choose to birth at home all the while the government will make sure your in good enough health to do it, maybe meaning the number of deaths brought on by homebirth each year will drop.

Forgive the long post I just wanted to put in my 2 cents. I truly believe there's a way to let mothers birth where ever they want but at the same time lower the mortality rate of babies being morn at home each year. It's not often I agree with both sides of a debate cause I'm normally firm with my beliefs but in this case I think both sides are right. A mother has the right to choose where she births but it's also neglect to go against doctors orders and home birth against thier advice.

Umm ... No.

"Protecting the baby" is not a reason to criminalize any part of childbearing. Especially since many of the issues raised in this thread can be directly traced to the behavior of the healthcare system and individual practitioners. Criminalizing decisions made by pregnant or laboring women does nothing to address those issues.

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Heron.....

Thanks for the reply, when you put it that way I can see where your coming from. I'm always open to hearing the other side of things and where they are coming from.

I only threw my 2 cents in cause reading everyone's response about this I can honestly agree and see both sides to this topic. I imagine that's the reason for it being such a debate. It was hard for me to agree with any one way cause like I said, valid points were made on both sides.

That idea simply came to me as almost a happy medium. Something that allows mothers to birth how they want when at the same time might cancel out some on the unnecessary deaths for the mom and baby.

Like I said, appreciate the feedback and I can totally see your side on this, it makes sense. Therefore I hope my post didn't offend any one

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Specializes in Hospice.

No offense taken:up:

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