Homebirth Gone Awry

HeartsOpenWide, RN · Oct 1, 2009

It is extreme cases like these that give home birth a bad name. I am all in favor of HB under the right circumstances and am a big fan of midwives, but this woman should not be allowed to practice...

And you can always find the right study to "prove" your biased opinion. Most studies show that homebirth is just as safe as hospital birth; then under the care of of train professional...

mamafeliz · Oct 1, 2009

I'll post the full text of article as can't use the links. I am posting for discussion. I believe in safety of home birth, and am actively working for better bridging between our hospital birth culture and the home birth culture in our area.

So, patience, the article is long!

Staff note: At allnurses.com we try to avoid copyright issues by posting only a short segment of a published article along with a link to the rest. The OP was unable to do this herself, but we were able to find the article and supply the link.

http://www.medscape.com/viewarticle/709194

Home Birth Gone Awry: Is This Typical?
Maria I. Rodriguez, MD
Published: 09/22/2009
Case History
Often, it is an especially busy night in Labor and Delivery when a patient with a disastrous clinical circumstance presents to the service. One call night, during my internship year, proved to be no exception. Although the events that follow happened many years ago, the encounter is indelibly etched into my memory. Hazel and her partner were brought in by their midwife "for pain medication." (Identifying details of the patient and midwife have been changed to preserve confidentiality.) Hazel had broken her bag of water 7 days earlier but had not started to feel any contractions until 5 days ago. She had been evaluated by the midwife when her water broke. Once labor began, someone from the birth center remained with her. Three days later, 2 days prior to presentation to the hospital, she developed a fever, and the contractions became stronger.

AOX4RN, MSN, RN, NP · Oct 2, 2009

Look at this reply: MedFake: Hospital Birth Gone Awry: Is This Typical?

SiennaGreen · Oct 2, 2009

What is it going to take the faciliate a better collaborative relationship between MD and MW?

Consumer demand.

$$$$$

What will it take to increase consumer demand?

Education, patience, diligence, grace, kindness, forgiveness. All difficult and time consuming.

AllieKat · Oct 2, 2009

this is just so sad.

i, myself had a homebirth and while it was the most personal, intimate childbirth i have ever had (for the 1st of 4 children) i never elected to do it again. luckily, there weren't any complications. it is just too easy for something to go terribly wrong in an instant. sometimes there may only be seconds or minutes to save the baby. so, the time needed to get to the hospital could have been timed saved and a life/lives saved.

not that all midwives aren't a capable and/or valueable asset to the medical community, but there are reasons doctors go to medical school for so long. even a birthing center would be a better option for when situations such as this one go awry. generally, a doctor will be available at a birthing center.

by the way, why on earth would a midwife (or anyone for that matter) allow a woman to keep laboring a week after her water broke? that is insane! i am not even in nursing school yet and i know that is extremely dangerous. isn't it you must deliver 24 hours after your water breaks due to infection or meconium?

i agree that this midwife has given a bad name to midwives.

AOX4RN, MSN, RN, NP · Oct 2, 2009

What is it going to take the faciliate a better collaborative relationship between MD and MW?

It will all be better as soon as midwives go away. Doctors have been working hard at it since the last century and with the increased publicity and safety studies (never mind this particular ANECDOTE), they have stepped it up a couple notches.

SiennaGreen · Oct 2, 2009

Unfortunately, women aren't being given safe, acceptable alternatives. If hospitals weren't such birth factories, "get 'em in, pit 'em up, strap a belt on 'em then stand in the hallway watching their activity on the monitor" that is no way to give birth- IMO- and a path I wasn't going to walk down for my birth experiences. I wasn't going there unless I had a true medical indication to do so, and being in labor doesn't count.

I fear that generations from now we will look back in this era and shake our heads, saying "How could we have been so arrogant and short sighted?"

SiennaGreen · Oct 2, 2009

Apgar,

It will all be better as soon as midwives go away.

Ha! It just makes me want to fight harder!

(and some days, move to some nice Scandinavian country where things are friendlier...)

CEG · Oct 2, 2009

I could write several stories called "Hospital Birth Gone Awry". I can if you want me to.

Evidence has proven over and over again that for the low risk patient a homebirth has equal mortality with REDUCED morbidity for mother and baby compared to hospital birth.

The United States stands alone in developed countries in supporting high-cost, high-technology maternity care for all women. The United States also ranks worse than most other countries in perinatal outcomes.

ACOG is a trade organization that protects the interests of its members. It is not an advocacy group for women, nor is it trying to improve health outcomes. If they were concerned with health putcomes they wouldn't advocate cesarean section for no medical indication- but when that is the subjectwomen suddenly deserve a choice (which conveniently involves MDs, makes their lives more convenient, and increases revenue).

Nothing against birth centers, but ACOG supports them as a political move. There is nothing about a birth center that is safer than giving birth at home, with the exception of possibly being closer to the hospital if a transport is needed (or of course someone's house could be closer to the hospital than the birth center). Midwives carry rescusitation equipment, blood volume expanders, etc. The physical presence of an MD changes nothing. In fact many MDs perform homebirths.

The key to homebirth safety is facilitating transfer. To the detriment of patients, people allow their personal beliefs to compromise the care women are given. Before my homebirth we had developed a plan of where to transfer in case of an emergency, printed the maps, and packed a bag complete with a copy of my medical records. Of note I would not have transfered to the hospital closest to my house, where I was an L & D RN, because they did not have 24 OB or anesthesia, all the women giving birth there who assumed they were safer than they were at home would actually have waited longer for emergency care than I would have with a homebirth transfer to a bigger hospital.

Doctors began trying to drive awar midwives at the beginning of the 1900's to get the money just like they are trying to do today. The difference is that homebirths and births attended by midwives have been on the rise for the past 30 years and continue.

L&Dnurse13 · Oct 3, 2009

I work in a hospital setting and I LOVE our midwives!!!!! They are awesome and allow low risk women to move around and some even allow fluids. Makes things easier on the mother. They are very supportive, do not rush a c-section unless necessary, will stay with the pt allowing them to push in whatever position feels best as tolerated by baby of course. That being said they also know when to call the MD in to take over. I also love our doctors. They are also great. But the midwife experience is more personal. They should continue to deliver. I am personally not a huge fan of homebirths as I have seen many times how a stable low risk mother can change in minutes to a high risk one. But to each his own. If you are well educated in the home birth experience and choose one for yourself, I am ok with that. I just don't like it when someone has not educated their selves and blame us when something goes wrong and they are rushed to us to fix it. The midwife here did not do what was right for this pt. You cannot blame all midwives for this.

CEG · Oct 3, 2009

some even allow fluids. Makes things easier on the mother. .

Just wanted to share that ACOG just came out in support of allowing clear liquids PO during labor. So although I will not expect to see things quickly, even ACOG supports it.