Home births gone wrong

Specialties NICU

Published

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!

Specializes in NICU.

Oh it's so infuriating! And then you have to be nice to these people. It sometimes takes all you have to hold back. I don't know how the docs do it either

Specializes in Women's Health.

Oh this topic makes me so angry too. It's hard to leave my biases at the door. I think planned home births are selfish. Being a L&D nurse, I would never in a million years plan to labor and deliver at home. I've seen too many things go wrong (in seconds!) that if you are not at a hospital with an operating room and blood products or a birthing center with licensed providers, oxygen, intubation equipment, etc. your baby (or you) can and will DIE. Is it really worth it to put your baby's life and your life at risk just so you can say, "I had a home birth and I totally rocked it."? The answer is NO... because you may rock the home birth but not have a baby to show for it. I'm with you. End. Rant.

The study cited isn't even published. It's a story in the lay press about a non peer reviewed study. It means as much as my grandma's opinion on home births.

Specializes in NICU.

One time we had a mom/baby that had no risk factors and was a planned home birth. Mom spiked a temp during labor, but the birth center they had arranged with for Plan B was full. So she came to my hospital. As expected, the rest of her labor was normal. And then the baby was born. And then coded. She had been continuosuly monitored. I think they decided there was an abruption, not sure.

But he was born at a hospital with a level 3 NICU, and within half an hour he had CPR, meds, HFOV, iNO, lines, pressors, blood products and hypothermia blanket. And he was fine. I personally don't agree with home births.

Specializes in CVICU CCRN.

Just during my short time in the OR we had 3 failed home births that ended catastrophically. One was a mom with placenta accreta who pushed against a 10lb baby for hours. We sectioned her in the main OR; She bled out right in front of us with her husband standing by her side. Hands down the worst case I've ever participated in. Baby made it.

Two others ended badly for the babies - both ended up on cooling protocol and were left with major deficits.

Prior to working as a nurse I spent many years working with families who experienced fetal demise or had kiddos in the nicu due to major congenital problems. I also did family advocacy work outside the hospital after the kids went home. I always thought I would be a nicu or Peds nurse. Those 3 home birth attempts (and a few others that I saw during nursing school) factored heavily in my decision to leave the nicu behind.

I know it's a controversial topic - I have friends who are midwives, doulas, etc. my best friend had her two kids at home. I totally support minimal interventions for healthy deliveries. But, like you, I became extremely frustrated at what I was seeing. The stakes and consequences are just so damn profound if something goes wrong.

I thought I was the only one who felt this way and felt a bit guilty that I wasn't more supportive when I had friends/family who wanted to deliver at home. I feel a bit better seeing I'm not alone in this.

Specializes in Healthcare risk management and liability.

I support the right of the mom to make decisions on home births. My wife at the time and I made the choice to have both kids in the major city hospital attended by an OBG. I am very biased on this insofar as one of my malpractice specialty areas are L&D/neonatal cases, and I have seen so many poor outcomes even with low-risk moms in tertiary medical centers with expert OBG attendings where things went bad very quickly. For us, a home birth was not an option that we personally felt comfortable with.

Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.

I developed HELLP syndrome after delivering my daughter. I had never heard of this before as I was a telemetry nurse and my L&D days were from the late 1970's. I did have mild pre-eclampsia but my OB was shocked when I started bleeding a couple hours after the delivery which went fine. It was then he returned me to the delivery room after he noticed my platelets were 40,000! He was checking for retained placenta but I keep bleeding out. Luckily the bleeding stopped as suddenly as it started. I also believe home births are dangerous as anything can go wrong in seconds.

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

My second child was a planned home birth. There is a lot I want to say to those of you who say I'm "selfish" but it would get me banned. I might return to this thread when I'm feeling more rational and not about to blow up at the ignorance demonstrated in this thread.

Specializes in CVICU CCRN.

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.

Specializes in ICU.

I never was interested in a home birth to begin with, but my recent experience cinched my disinterest. I had a terrible delivery. Everything seemed to be going alright except for the last few minutes of pushing. The baby's heart rate dropped to 0, forceps were used to pull her out, and she coded for 15 minutes. She was on the cooling blanket, a vent, and so forth.

I never thought this would happen to me BUT anything can truly happen during birth! I am grateful that I was in the hospital. I am even more grateful that I was in a hospital with a NICU team. I know she would not be alive if this were a home birth.

Bad things can happen at home or the hospital, but I would rather have professionals/medications/equipment quickly available if the situation arises.

MANA's own stats back up the X 4 rate of death - and that's coming from the midwives own information! I think home birth can be safe if mom's are chosen from strict guidelines, however in the US there is a huge range of midwives' knowledge and education. People honestly think the worst thing that can happen is a c-section, but we see the other side of the coin.

Home births occur where there are inherently less emergency resources than in the hospital. If something very unexpected happens, then there is certainly a chance that help will come too late. I do think that happens sometimes even when a patient is low risk and an appropriate candidate for home birth. However, there are many who choose home birth who are not low risk and who choose an inadequately prepared birth attendant. This seems to the majority of the train wreck cases. I worked with a CNM who did many home births mostly with the Amish. She came to us in the hospital after doing home births for about ten years. This midwife was excellent. She followed protocols to a T. She gave patients every chance, but would also honestly share her opinion if she thought C/S was appropriate.

Then we have another person in the community who is some groovy yoga chick. She is a CPM and brags of VBAC'ing twins at home on her "magical"l website. She is an obnoxious hospital doula or she will take her full scope of CPM skills to the home. Her and several like minded of her colleagues are the train wrecks we see in the hospital.

I'd never have a home birth. Birth is normal and birth is wonderful. In rare cases, it does turn into a situation where a few minutes mean life or death. That being said, caregivers in the hospital often have poor judgement and inadequate skills.... and poor outcomes. If a patient is fully informed, is low risk, and is in the care of a competent caregiver then I think homebirth should be a choice for those patients and caregivers. The real idiots out there need to be stopped. If that happened, there would still be some "bad" situations, but far fewer.

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