Home births gone wrong

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 ER.

I had 6 homebirths. Sadly, the American medical system supports interventional childbirth. Home birth is oppressed in most of the nation, making it inherently more dangerous.

My best experiences were in New Mexico and here in Washington State, where there were guidelines and oversight, and quality, certified midwives. In S Carolina I had a Dr attend. In California we homebirthers had to use lay midwives who where doing their best, but making up their own rules because the oppressive medical establishment there would not allow more legitimate avenues. I saw negative outcomes there as a result, including deaths of babies.

Up Vote Up Vote ×
Specializes in Healthcare risk management and liability.

I will point out that a possible reason for lack of enthusiasm on the part of some physicians may be because they can be left legally holding the bag if an adverse outcome occurs for deliveries done by someone else. In my experience, many lay or licensed midwives and some of the birthing centers have inadequate or no . 'Adequate' levels of insurance would depend upon the unique statutory, regulatory or case law of your jurisdictions, but if I was delivering babies for a living and was in a state with no damage caps or a state compensation fund, I would have at least $ 2 million in limits as an individual and $ 10 million as a facility.

I have seen several lawsuits in which the baby sustained significant injury during the birth at home or birthing center, and the die was cast by the time mom and baby arrived at the hospital. The physician and the hospital represented the only deep pockets to get the money to care for the baby since the physician and hospital have insurance and the midwife and center did not. Depending on how that jurisdiction applies joint and several liability, the physician and hospital may end up paying the entire verdict, even if they were only minimally negligent compared to the actions of the midwife or birthing center. Depending on how that jurisdiction applies comparative/contributory negligence, the amount of the verdict may be reduced by the negligence of others, such as the parents, midwives or birthing center.

For the providers who do a lot of deliveries, issues of liability for delivering babies is usually not far from their minds, since this is one of the areas of medicine in which multi-million dollar verdicts are not unusual. I have met many midwives who feel they are immune from this, since they are female and they emphasize patient relationships. Both of these are great and no doubt help somewhat, but again in my experience, that goes right out the window when a significant adverse outcome occurs and the parents are looking to fund 24/7/365 day care for a profoundly injured baby who will possibly never live independently. People can do strange things when they think there is money to be had.

This concept of course also applies to physicians doing deliveries and the OBG or neonatologist comes in and tries to save the day and can be left holding the bag. The major difference in that instance is that the original physician likely has malpractice insurance to defray at least some of the costs.

Up Vote Up Vote ×
Specializes in OB.

Agree with your points, RiskManager, but the paradox is that it is almost impossible to GET as a licensed homebirth midwife (unlicensed midwives obviously have zero chance). There is one company in the U.S. that offers it, and it is about $50,000 per year. So most go without, and hedge their bets. Obviously this can and does backfire frequently.

Up Vote Up Vote ×
Specializes in Hospice.

Along similar lines, I had my son at home, attended by a lay midwife and the ob/gyn with whom she practiced (he pretty much held the mirror - but he was on hand whenever he could be to back up the midwife and take over if necessary). The practice had extensive guidelines for when they would attend a home birth, including maximum distance from emergency services. They stopped offering homebirths soon after my son was born due to exploding malpractice costs. The practice went back to hospital based service and the midwife went to Vermont.

It is possible to have both as part of a spectrum of care. Opinions may differ on which side created the dichotomy and why.

Up Vote Up Vote ×
Specializes in Healthcare risk management and liability.
Agree with your points, RiskManager, but the paradox is that it is almost impossible to GET malpractice insurance as a licensed homebirth midwife (unlicensed midwives obviously have zero chance). There is one company in the U.S. that offers it, and it is about $50,000 per year. So most go without, and hedge their bets. Obviously this can and does backfire frequently.

Here in Washington, the commercial carriers stopped writing midwife insurance many years ago, so the local malpractice insurers worked with the State to create a joint underwriting association to provide coverage to licensed midwives, CNM and licensed birth centers. I am proud to have been part of the team that got the JUA up and going and have given them advice and help over the years: Washington State JUA

Up Vote Up Vote ×
Specializes in OB.
Here in Washington, the commercial carriers stopped writing midwife insurance many years ago, so the local malpractice insurers worked with the State to create a joint underwriting association to provide coverage to licensed midwives, CNM and licensed birth centers. I am proud to have been part of the team that got the JUA up and going and have given them advice and help over the years: Washington State JUA

So awesome!

Up Vote Up Vote ×
Specializes in ER.

Washington State definitely works well with both home brithers and home schoolers, tolerating and supporting.

Up Vote Up Vote ×

Your OP stated your job is not to judge, but clearly you do if a parents decision go against what you think they should do, act and react.

Up Vote Up Vote ×
Specializes in Hospice.
Your OP stated your job is not to judge, but clearly you do if a parents decision go against what you think they should do, act and react.

She gets to vent.

Up Vote Up Vote ×
Specializes in NICU, PICU, educator.

We have a bunch of horrible lay midwives that we encounter every now and again. All of our Level 3's in the area have been receipents of devastated kids from them. The thing that gets me is that the parents never ever feel that the "midwives" have done anything wrong! They circle the wagons and protect this group. I just don't get it.

Low risk home births with a certified midwife who is connected to a hospital or birthing center can be fine, but these crunchy crazy lay midwives are dangerous and in my opinion should be arrested when we get a bad kid from their incompetence.

Up Vote Up Vote ×

Reading through the comments I think that home births would not be the safest but like abortion I think it is the woman's right to choose. In cases where nurses have had to care for babies with poor outcomes It must be heart breaking. Having negative feelings about the mothers of these babies I am sure is unavoidable but I only feel sadness for the parents and the babies.

Up Vote Up Vote ×
Specializes in LTC, CPR instructor, First aid instructor..

I prepared for the home birth of my daughter by reading a book on how to prepare for a home birth from the Laleche League. When she was being born, I asked my husband to catch her, then told him where to tie the umbilical cord. (She began to cry immediately) I then told him to lay her on my tummy where she began nursing.

Up Vote Up Vote ×
+ Join the Discussion