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!

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

That is a key point. It sounds like most of the horrible outcomes described here are either due to moms ignoring medical advice regarding their high risk, or poorly trained midwives not adhering to well researched and thought out guidelines regarding when to say when and transfer a patient.

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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.

What.An.Idiot.

That just makes me sick.

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There's more than Idiot there IMHO. There's some Mental Illness afoot as well, which tends to Colour that tragedy in overtones of Negligent Homicide. Terrible indeed.

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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.

Couldn't have said it better myself!

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Specializes in NICU, Trauma, Oncology.
Are these midwives nurse midwives or lay midwives?

Yes! That is my question also.

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Specializes in NICU, Trauma, Oncology.
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.

I wish I could like this a million times

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Specializes in Adult and Pediatric Vascular Access, Paramedic.

Hi,

I don't have issues with home births, as long as the midwife is educated and knows when to draw the line and go to the hospital or not have a home birth at all (ie. breech presentation, Placenta Acretta, placenta previa) . I can understand why many women are turned off by laboring at the hospital and want to have a much quieter and private experience in their own home with minimal medical intervention. I think home birthing is like any other medical event in that it should only be done with a professional present and under informed consent in that both the mother and father are informed of the risks prior to making the decision.

From what the OP is saying, I gather many of the issues and bad outcomes have to do more with untrained or minimally trained midwives that are not providing the risk vs benefit information to the parents, as well as not informing parents when it would be safer to have the baby in the hospital. I am sure their are also parents that are just dead set on delivering at home, no matter what anyone tells them.

I work on the ambulance and a few months ago we had a couple that delivered their child at home without anyone present, but themselves. No midwife, nothing! As I predicted they dialed 911 when they saw all the bleeding post delivery and wanted us to tell them that she would be fine, which of course we cannot do. We of course recommended both the baby and mom get seen at a hospital, but she refused. The baby was not being seen by a physician for several days either. To me this was a VERY selfish thing to do because she put both herself and her baby at high risk, when it wasn't necessary.

Just my .02 cents!

Annie

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Specializes in NICU, PEDs, Skilled Home Care, Biologics.

The name of the game is Russian Roulette. Educate yourself on the rules of the game then make your choice as to whether you want to play or not. I chose not to play.

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Specializes in Hospice.
The name of the game is Russian Roulette. Educate yourself on the rules of the game then make your choice as to whether you want to play or not. I chose not to play.

What does that mean - that you're not having kids?

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I had 2 of my babies at home with a CNM. I had a back-up OB and emergency items available, including oxygen. If I had been strep B + I would have received IV antibiotics. My CNM is a nurse first, who would not accept me (nor would the backup OB) if I was not a good candidate. As a mother and a nurse I am disturbed by those that would knowingly put babies at risk. Of course there is an element of risk for even low-risk mothers, but please remember that many of the interventions that are routinely done in hospital also carry increased risk for adverse outcomes. These days a hospital birth is considered "natural" if it doesn't involve surgery! I would advise women to use their critical thinking skills and to make sure they understand the risks up front.

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I had 2 of my babies at home with a CNM. I had a back-up OB and emergency items available, including oxygen. If I had been strep B + I would have received IV antibiotics. My CNM is a nurse first, who would not accept me (nor would the backup OB) if I was not a good candidate. As a mother and a nurse I am disturbed by those that would knowingly put babies at risk. Of course there is an element of risk for even low-risk mothers, but please remember that many of the interventions that are routinely done in hospital also carry increased risk for adverse outcomes. These days a hospital birth is considered "natural" if it doesn't involve surgery! I would advise women to use their critical thinking skills and to make sure they understand the risks up front.

It's great that you had such a conscientious and educated provider.

And, it's great to say that women should use their "critical thinking skills" to determine their own childbirth experience.

How exactly are women in the U.S. supposed to do that? There are no rules or regulations regarding home birth. In most states literally anyone can call themselves a midwife.

If someone presents themselves as educated about childbirth, or any health related issue, then most lay people are going to trust them. There are no state boards policing their actions. They don't carry , so there are no lawsuits. They aren't licensed by the state, so there are no regulatory boards to report them to.

Telling women to use "critical thinking skills" is just another way to blame the victims when they are deceived by these so-called professional midwives and end up with bad outcomes.

Individuals who are uneducated in women's health are easy to deceive and manipulate, which is what these midwives depend on. A governing body of educated health professionals is not, which is why they are so resistant to mandatory licensure and adopting standards of practice.

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I am nervous, somewhat, to jump into your thread since I'm not a nurse, NICU or otherwise. But I read this post last week & keep thinking about it & the OP. So, firstly, I'm a former homebirth midwife. DEM actually. Was fortunate to have attended only homebirths with positive outcomes & only one transport (for a prolonged slow bleed, luckily you could see the hospital 2 blocks away, quick transport). New parents & their babies are just a wonder. Beautiful.

To OP----Absolutely it is right for you to judge. Absolutely! You are a trained medical professional, you have the right to discern when commonsense and appropriate action has been used in the care of an individual & when it hasn't. Being judgemental in a social context is generally considered wrong. Using judgement based on facts, as best that can be dtermined, is correct to do. The fact is this, breech births are better handled in a medical setting. They just are. Statistically. Factually. Now, that the mother had other plans is her choice-----coming from what reasoning, is not revealed in your post. We don't know. The midwives that accepted her for an attempted homebirth is another thing altogether. Hubris, lack of awareness of potential crisis---does it matter? You can judge them for their actions. No doubt, the transport could've happened much sooner. And for the poster who wrote about a midwife stating that a baby that had died 'just wasn't meant to live' , well that's the statement of a psychopath, plain as anything. Too bad it was a midwife, but they're found anywhere.

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