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!

[RiskManager]

Reminds me of the continuous fetal monitoring large scale studies that have been done- even if it makes us all feel better, continuous fetal monitoring does not improve outcomes, but does increase one's risk for having a c-section.

True dat. I am also reminded of a very well-known plaintiff counsel colleague of mine, who likes to say that if you don't see worrisome decels or bradycardia on the FHM tracing, you just aren't looking hard enough. Of course, they have the luxury of the 20/20 retrospectroscope, when there has already been a poor fetal outcome, and everyone has the leisure to pore over and ponder the tracings knowing there has been a poor outcome.

[Elvish, BSN, DNP, RN, NP]

True dat. I am also reminded of a very well-known plaintiff counsel colleague of mine, who likes to say that if you don't see worrisome decels or bradycardia on the FHM tracing, you just aren't looking hard enough. Of course, they have the luxury of the 20/20 retrospectroscope, when there has already been a poor fetal outcome, and everyone has the leisure to pore over and ponder the tracings knowing there has been a poor outcome.

I almost wish we'd completely do away with EFM. I can't tell you how many times I've had a beautiful baby trace without the first variable or late decel (earlies are fine!) and come out limp as a dishrag. On the flip side, I've watched the crappiest tracing, just terrible and looking like a stairway to Hades, result in a pink beautiful baby with 9/9 apgars. EFM tells you a lot but one thing it isn't good at telling you is what kind of baby you're going to get once the cord is clamped.