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!

Almost every situation sited in this thread sounds not like a home birth gone wrong but a mal-practicing midwife. Births with anticipated complications like breech, gbs, etc should be in a Birth Center or hospital. It really bothers me that the jump is made to "home birth is bad".

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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.

The logic escapes me that if you "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" then why would you choose to have an OBGYN attended delivery in tertiary medical center. Seems like you would NOT choose that?

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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.

Curious to know how home births are safer than hospital births?

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Specializes in ORTHO, PCU, ED.
Almost every situation sited in this thread sounds not like a home birth gone wrong but a mal-practicing midwife. Births with anticipated complications like breech, gbs, etc should be in a Birth Center or hospital. It really bothers me that the jump is made to "home birth is bad".

The OPs post and the example she gave specifically mentions that physicians warned the mother she needed a C-section due to a breech baby. Her point is that the home birth should not have taken place in this instance and you mention "anticipated complications like breech should be in a birth ctr or hospital." This is her point in the post. I did not take her post as some did that home birth should not be an option, but more that she's angered at the mothers who have complications like you mentioned and still pursue home births and have a not so happy ending. I agree women should have a choice myself. I don't agree that they should attempt a home birth if they knew they were at risk due to complications like you mentioned. Surely that's common sense?

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Specializes in Healthcare risk management and liability.
The logic escapes me that if you "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" then why would you choose to have an OBGYN attended delivery in tertiary medical center. Seems like you would NOT choose that?

The point is I have seen poor outcomes even in settings with the maximal amount of resources available in the event of an emergency. I have seen even more poor outcomes in settings that had considerably less resources available, such as home birth or high-risk deliveries in rural hospitals by a FP. So when we had children, we tried to stack the odds in our favor by choosing a setting with those maximal resources available.

Washington state is interesting insofar as we have lay, licensed and nurse midwives and freestanding birth centers. Most of the nurse midwives I know are employees of hospital/healthcare systems and deliver in the hospital. A very few nurse midwives do the birthing center, and I cannot think of any off the top of my head who do home births. Most of the home births I am aware of are by lay or licensed midwives. The liability insurers will generally not allow physicians or nurse midwives to do planned home births.

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I swear, the time has come to write a book to blow the lid off this "natural health" movement. I remember in clinical practice a mother who came in with HELLP and was stable, but due to the influence of her -non nurse- "all natural" midwife would not let us push IV fluids or magnesium. We lost her and the baby in a totally preventable seizure. Someone needs to write a book about all the ways the "natural health" community spews pseudoscience that at best helps nothing and in the worst cases, delays treatment till it's too late.

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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.

American attitudes about home birth are really weird to me because it's so normal and common where I'm from (Netherlands). I don't think you're "selfish" or abnormal at all. :)

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Specializes in OB.

OP, thank you for your perspective. I know it must be horrible to see babies have such terrible outcomes. I respect the work of NICU nurses enormously. The fact that you heard a midwife say "that baby wasn't meant to live" makes me sick.

However, I think two things seem to be happening in your case: you seem to be in an area with particularly dangerous, untrained midwives who are not practicing appropriately, and you are ONLY seeing the bad outcomes of home births, and not getting exposed to the vast majority of home births that have completely safe outcomes.

As a CNM, I got the privilege to do my final semester in the home birth setting with a CNM. There I learned how normal birth can be and how powerful women are. Right now I work as a CNM in a hospital, and while I still get to learn those things every day, I am planning a home birth for the birth of my first child.

Most people in this country have never been to a home birth and only know about it from some scary story of a bad outcome, and then can confidently brand women "selfish" for doing so. This saddens me. Most people also assume that all bad outcomes in the hospital are the result of the inherent danger in birth, that all interventions were used appropriately, and "Thank God we had all those doctors and equipment and access to an OR to save you and your baby!!!" In fact, I would venture to say MOST bad outcomes in the hospital are due to unnecessary intervention in the first place! Of course not ALL are, and thank God we have OBs and ORs and anesthesia and blood transfusions and antibiotics. But I can give you just as many stories about women's lives being irrevocably changed because of bad decisions made in the hospital.

I saw an 18 year old mother die in childbirth because a doctor ignored the midwife's concerns about the patient's bleeding during pushing, and then life-saving measures were taken far too late. I've seen a 23 year old woman lose her uterus because the incompetent doctor didn't know how to use a vacuum to deliver the baby (all that was needed was probably 1 pull), instead made excuses for why she needed a C/S, then nicked an artery in the surgery without knowing it, closed the patient, and one day later, the patient required a hysterectomy. I have seen countless women bullied, humiliated, and severely physically and emotionally traumatized from their hospital births. To say that the only outcome that matters in childbirth is a "healthy" baby is simply too myopic.

It is wonderful that in the OP's hospital, they have a lot of options for low-intervention birth. However, this is not the case for most women in the country. The choices are a high-intervention birth in a hospital with an OB, or home birth (some places don't even have access to home birth midwives, and some women opt for unassisted birth!). Women have to look at the risks of both settings, and make their own choices. Sometimes this results in a bad outcome, which is awful. But to completely malign home birth as dangerous and hospital birth as safe is just foolish.

Home birth with a CNM (in my area most home births are attended by licensed midwives, there are few CPMs) doesn't require eschewing any routine prenatal testing or standards of care. You have access to all of the normal blood work, screenings, ultrasounds, etc. Some people CHOOSE not to have an ultrasound, for example, so yes, you could have an accreta and not know about it and bleed out and die. But this is not BECAUSE they had a home birth, KWIM? If there are unlicensed midwives in your area practicing dangerously, they need to be reported and prosecuted.

At the end of the day, childbirth, while mostly normal and safe, does have risks, and will always have risks. Women and babies will sometimes die in the process. It is so terrible, but it's the truth. We cannot eliminate risk in OB. As such, women have the right to assess their options for birth in their area, weigh the risks and benefits of all birth settings, and make their own decisions.

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Specializes in Healthcare risk management and liability.

^^^This is a very key point: I often remind my colleagues that in any aspect of medicine or nursing, 98.4 % (a completely made up number) of the time, everything goes just peachy. When you work only on the disasters, it tends to skew your perceptions.

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Specializes in Women's Health.

I think I was a little too heated in my original post. Now that I've had some time to think about it, I will try to tone it down a notch. I am in no way saying that labor and delivery in a hospital is the best and most glorious way to bring a baby in to this world. I, too, have seen lots of unnecessary interventions in a hospital. I have seen the incorrect use of vacuums and forceps, AROM for no particular good reason, and the push for unnecessary c/sections (among many other things)- all of which makes my blood curl. I have also seen and been a part of many moments where we have saved a baby's or mom's life in a matter of minutes.

Like many other labor nurses and CNMs I work with, I am a self-proclaimed hippy”. I am the RN who opts for a CNM, clothdiapers, essential oils, low interventions, labor ball, natural childbirth… the works. I just simply cannot turn a blind eye to all of the things that could occur during childbirth that would put me and my baby at risk by delivering at home. I have seen how emergent situations like a prolapsed cord, abruption, placenta accreta, cervical laceration from pushing against the cervix, shoulder dystocia, prolonged ROM and subsequent chorio diagnosis, hemorrhage, etc. have all had extreme impacts on both mother and child. While I am all for low-intervention, I personally can not and will not choose a home birth because of the small percentage of risks involved with not having immediate access to a hospital.

I am the nurse who will advocate for you, try to follow your birth plan to a T”, do intermittent fetal heart tones while you are in the shower or tub rocking your hips through contractions… but please, let me be there to help intervene should you or the baby become distressed. I respect the power of a woman's body and her (and her partner's) right to make informed decisions, but it is just so hard to continue to see the bad outcomes that come in to the hospital after attempting a home birth.

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Specializes in OB.
I think I was a little too heated in my original post. Now that I've had some time to think about it, I will try to tone it down a notch. I am in no way saying that labor and delivery in a hospital is the best and most glorious way to bring a baby in to this world. I, too, have seen lots of unnecessary interventions in a hospital. I have seen the incorrect use of vacuums and forceps, AROM for no particular good reason, and the push for unnecessary c/sections (among many other things)- all of which makes my blood curl. I have also seen and been a part of many moments where we have saved a baby's or mom's life in a matter of minutes.

Like many other labor nurses and CNMs I work with, I am a self-proclaimed hippy”. I am the RN who opts for a CNM, clothdiapers, essential oils, low interventions, labor ball, natural childbirth… the works. I just simply cannot turn a blind eye to all of the things that could occur during childbirth that would put me and my baby at risk by delivering at home. I have seen how emergent situations like a prolapsed cord, abruption, placenta accreta, cervical laceration from pushing against the cervix, shoulder dystocia, prolonged ROM and subsequent chorio diagnosis, hemorrhage, etc. have all had extreme impacts on both mother and child. While I am all for low-intervention, I personally can not and will not choose a home birth because of the small percentage of risks involved with not having immediate access to a hospital.

I am the nurse who will advocate for you, try to follow your birth plan to a T”, do intermittent fetal heart tones while you are in the shower or tub rocking your hips through contractions… but please, let me be there to help intervene should you or the baby become distressed. I respect the power of a woman's body and her (and her partner's) right to make informed decisions, but it is just so hard to continue to see the bad outcomes that come in to the hospital after attempting a home birth.

I appreciate your perspective. I think people should of course choose a hospital birth if they aren't comfortable with home births themselves. I have no problem with that whatsoever. It sounds like you go above and beyond for your patients.

I also forgot to mention in my post the numerous issues that can come with transferring from home to hospital. In some places, this is such a contentious situation, full of blaming, name-calling, and real punishing behavior, that I do feel some midwives transfer too late, hoping to avoid the confrontation for that patient's sake. This is a real problem. As a poster above me mentioned, in countries like the Netherlands, where I believe something like 30% of women deliver at home, they have seamless systems for transfer. Instead of attitude and blame, midwives are appreciated for adhering to pre-established guidelines for when women should be brought in. This keeps the whole system working better and safer for moms and babies.

This article expresses my views pretty well:

http://www.nytimes.com/2016/01/26/upshot/how-to-make-home-birth-a-safer-option.html?_r=0

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Specializes in Pediatrics, NICU.

This is a thread meant for nurses and NPs who work in the NICU and was about how to cope with home births that went badly. Of course our perspectives are skewed. We see home birth babies only when the birth went horribly wrong and usually have devestating outcomes.

I'm sure that there are wonderful midwives out there who assist with home births and recognize when things are going badly, when to transfer care, and how to appropriately resuscitate when needed. The ones in my area are terrible and I would deliver unassisted before I would let any of them touch me or my baby.

Personally, I don't believe that people who deliver at home are selfish, but I think some are misguided. Such as my previous example of the frank breech baby who died, that mom also stated that she would prefer her baby die than be born at a hospital. That's just plain wrong. I have also met families that intended to deliver at home but their plans were changed and they were very pleasant parents to work with and I would never describe them as selfish or uncaring about their baby.

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