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!

Specializes in OB.
That is fair, given your experience, both professional and personal. The overwhelming truth that goes through my head reading this thread is that we are an arrogant society, thinking that the reason our infant mortality is low is because we are so advanced. It is low because we have overwhelming majority acute setting births! Home setting births will maintain third world mortality rates because, although the homes don't have dirt floors, the emergency support is identical. I have no experience with these practitioners, but I doubt that that figure is brought up when selling their services. I am sure it is very difficult to work in an area where these tragedies could be averted and have to see the result of a choice they may not have made, but that is what must be kept in perspective, these women, families, made the best choice that they believed at the time. Just like someone can not fathom the logic behind someone who has opposing political views.

I'm sorry but what you're saying just isn't true. Our infant mortality rate is NOT low in the U.S., it's extraordinarily high compared to other industrialized nations. Even when you adjust for the fact that we save younger premies than most other countries, we still lag behind, in something like 38th place amongst industrialized nations. Home births in the U.S. do NOT have the same infant mortality rates as home births in 3rd world countries, that's completely false. Most home births in 3rd world countries are completely unattended, which automatically puts women and babies in enormous risks. And finally, as has been brought up before, skilled home birth midwives do bring emergency equipment like O2, hemorrhage medications, IV fluids, and suction kits for babies. If there are midwives out there not practicing with all of these supplies, as I've stated, they should be reported and prosecuted. But what you're describing is not the norm for home birth in the U.S.

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Specializes in IMC, school nursing.
I'm sorry but what you're saying just isn't true. Our infant mortality rate is NOT low in the U.S., it's extraordinarily high compared to other industrialized nations. Even when you adjust for the fact that we save younger premies than most other countries, we still lag behind, in something like 38th place amongst industrialized nations. Home births in the U.S. do NOT have the same infant mortality rates as home births in 3rd world countries, that's completely false. Most home births in 3rd world countries are completely unattended, which automatically puts women and babies in enormous risks. And finally, as has been brought up before, skilled home birth midwives do bring emergency equipment like O2, hemorrhage medications, IV fluids, and suction kits for babies. If there are midwives out there not practicing with all of these supplies, as I've stated, they should be reported and prosecuted. But what you're describing is not the norm for home birth in the U.S.

Then I correct my statement to 2nd world country. My post was neutral, neither pro or con. Access to emergency equipment can't compare to an OR and blood products, but if one is aware of the limitations, then she can make the choice that is best for her.

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Specializes in ORTHO, PCU, ED.
That is fair, given your experience, both professional and personal. The overwhelming truth that goes through my head reading this thread is that we are an arrogant society, thinking that the reason our infant mortality is low is because we are so advanced. It is low because we have overwhelming majority acute setting births! Home setting births will maintain third world mortality rates because, although the homes don't have dirt floors, the emergency support is identical. I have no experience with these practitioners, but I doubt that that figure is brought up when selling their services. I am sure it is very difficult to work in an area where these tragedies could be averted and have to see the result of a choice they may not have made, but that is what must be kept in perspective, these women, families, made the best choice that they believed at the time. Just like someone can not fathom the logic behind someone who has opposing political views.

Your post is not pro or con? Could've fooled me. And it's also a bit rash, "assumptive" and seemingly uneducated quite frankly. Did you not read LibraSun's posts??

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Specializes in Hospice.
Your post is not pro or con? Could've fooled me. And it's also a bit rash, "assumptive" and seemingly uneducated quite frankly. Did you not read LibraSun's posts??

Thanks CBlover.

MrNurse, I'm also a bit annoyed by your remark about alternative providers "selling their services" (emphasis yours).

Are there self-serving scammers out there? Of course! And I agree that they use all kinds of gerrymandered information to sell substandard or dangerous krep.

But let's keep those facts in context, OK? That context includes everything from the rest cure and lady partsl deodorants to DES and the Dalkon Sheild. Women's health, including their reproductive health, is a profit center for a whole lot of industries, including health care. False advertising and venality are not confined to local earthy-crunchies.

But that's another thread. Meanwhile, you clearly do not view home births positively. So - what do you think should be done and why?

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Unfortunately we only see the "bad" outcomes. In my area we have a lay midwife that has lost creditably with the nursing staff long ago. When her patients come in they are train wrecks. Pushing for 5 hours against a 8 cm cervix, push with a FHR in the 90s...turns out that was the moms HR....baby had no heart rate when she come in by rescue for "exhaustion", and a PP pt that was allowed to slowly bleed out for 6 hours before being brought in because she was "dizzy & couldn't hold the baby to breastfeed". They only gave her apple juice thinking it was her blood sugar. Turns out she had a cervical tear and retained placenta. These are just a few examples....and each time it happens, we have to wait for charting, prenatals and other information because she "has to gather my thoughts".

It is hard to not be frustrated when these cases come in.

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Specializes in OB.
Unfortunately we only see the "bad" outcomes. In my area we have a lay midwife that has lost creditably with the nursing staff long ago. When her patients come in they are train wrecks. Pushing for 5 hours against a 8 cm cervix, push with a FHR in the 90s...turns out that was the moms HR....baby had no heart rate when she come in by rescue for "exhaustion", and a PP pt that was allowed to slowly bleed out for 6 hours before being brought in because she was "dizzy & couldn't hold the baby to breastfeed". They only gave her apple juice thinking it was her blood sugar. Turns out she had a cervical tear and retained placenta. These are just a few examples....and each time it happens, we have to wait for charting, prenatals and other information because she "has to gather my thoughts".

It is hard to not be frustrated when these cases come in.

This is horrifying. Can't she be reported to the police? CPS? In my area both CPMs and CNMs are licensed and there are no other midwives that I've ever heard of (meaning people with literally no training who just "call" themselves midwives). So I'm not really in the best place to give the correct advice because there is a process here by which to discipline a midwife, but surely there has to be a way to get the problem recognized. Hell, I'd start by just posting on all the online mothering/parenting forums where women might ask for reviews and experiences of different midwives, and tell the truth about her.

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Specializes in Healthcare risk management and liability.
Hell, I'd start by just posting on all the online mothering/parenting forums where women might ask for reviews and experiences of different midwives, and tell the truth about her.

I hate to be RiskManager buzzkill, but doing this would very likely leave you open to civil liability for slander or defamation, which is not covered by your professional , but may be covered if you have personal umbrella coverage over your homeowner's or renter's insurance. I would not bet the farm on the insurance coverage, though.

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Specializes in NICU.

We would all love to do this but HIPPA prevents us from mentioning how we know about these situations. We can't risk our licenses. Everyone just assumes a midwife is a midwife they aren't really looking into what their credentials are.

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Specializes in Hospice.

I should think that it would be possible to give accurate clinical information, and counter misinformation, without pinpointing anybody.

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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.

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First, I want to add this article to the discuss. It's ACNM's response to the CDC study about home births having 4x higher infant mortality rate than hospital births and includes some good points. http://www.midwife.org/acnm/files/ccLibraryFiles/Filename/000000003851/ACNM-SMFM-Home-Birth-Abstract-Response.pdf

Also, I'm trying to find the link but ACNM also just recently (like within the last 1-2 years) released data supporting the safety of home birth with a properly trained provider following certain guidelines.

Now to my personal experience. I've seen terrible things roll into triage when homebirth goes wrong. We had a woman come in who reported her water broke over a week ago but her midwife told her it was fine and to stay home. She was so infected you could barely stand in her room because of the foul odor. And baby was long dead. We had another mom roll in with her homebirth midwife who had been pushing for 12 hours and upon exam was found to have a closed cervix and the fetal heart tones were in the 50s. One more horror story, we had a home birth midwife attempt a delivery that ended with a severe shoulder dystocia which she attempted to resolved herself for nearly 30 minutes before coming to the hospital, at which time baby was long gone and the spinal column was detached from the aggressiveness the midwife had used to attempt to deliver the baby. Unfortunately in all of these situations, the midwives were lay midwives with no license and therefore there was no legal action that could be taken against them (at least according to our laborists).

That being said, I still support homebirth! However, the general public (in the US) needs education about homebirth, hospital birth, and midwives! People need to know the difference between a lay midwife and a certified nurse midwife so when they are choosing a birth provider they are truly making an informed decision. There needs to be better regulation in the practice of midwifery so that people who have no business delivering babies are punished for their missteps when they inevitably happen. There needs to be better systems for women who desire a homebirth to be transferred to hospitals without all the negativity and tension between providers if necessary. And there needs to be better trust between women and their providers.

The hospital I work at has recently open a 6 bed natural birthing center. We are finding that the women who desire to deliver here need better information about the guidelines to admitted to the birth center and what happens when they risk out. I think the vast majority of women (at least in my experience) don't realize just how fluid the plan needs to be when it comes to labor and birth. Things happen and change and you have to keep that in mind. Yes, you could be low risk and have a healthy pregnancy but when your labor starts, your baby may be stressed out by something and pass meconium or have Category II heart tones (risk out situations for our birth center and in my mind for home birth). Women need to be educated that if/when things like this happen, it's not a failing on their part or that they have done anything wrong but that at that point, it's safer for them and their babies to be closer to medical interventions that may be needed. I think even though a lot of the blame for poor homebirth outcomes does rest with inappropriate birth attendants, some of it also rests with mothers who have not been educated or who are unwilling to be flexible with their "ideal birth plan."

Just my two cents.

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Your stats are wrong for home births, evidence based best medicine states home births have less complications than hospital births with appropriate screening tools for low risk deliveries. Canada and Europe teach and do lady partsl breech births, the US is a decade behind in catching up. Unfortunately there are not many OB's left who can teach the next generation of OB's. Watch the movie "Heads Up" it has a lot of the current facts which many OB's will not follow because they never had the training. ACOG has a statement paper that says a lady partsl breech birth has a healthier baby than a C-birth baby.

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