Homebirth Gone Awry

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New article written by an OB/GYN with case study and following discussion of home birth. Google search "Home Birth Gone Awry" and follow link to medscape article by Maria Rodriguez MD. Interesting read for all working with birth. Sorry I cannot post effective links to article!

Gosh, it's a tough topic to tackle, but personal choice is still boss, in my opinion.

I've had 3 children, all hospital births, however, I wish I could have delivered at home b/c there are so many things that make hospital births really unpleasant. One of them being that what you want must be discarded for protocol or hospital policy. And the other being that what you want is often replaced with what is considered better/preferred/or most convienient by your care provider.

On the other hand, my last birth, had I chosen to try to deliver at home, would have ended up in the hospital, most likely with a dead baby.:cry: Fortunately, I have a healthy 4 year old little boy sitting at the kitchen table right now with his brother and sisters:redpinkhe (Not to mention I probably would be dead right now to.)

I'm thankful that I was able to experience both sides of the story, I think its gonna make me a better nurse. I know what it's like to be the patient in the hospital who loathes much of the standard birth procedure, and I also know what its like to be the person who 'really needed' the hospital birth.:twocents:

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That was actually an excellent article that outlined something so important, facilitating transfers. The story itself was outlandish...I can't imagine a midwife so incompetent that she would allow her client to have a fever with ROM for that long, or heart tones on a baby that low...certainly not the standard of care among ANY midwives I know.

I had two babies out of hospital (birth center, then home) and planned a homebirth for my third. I ended up needing to transfer and felt so fortunate to live in a progressive area for birth. The transfer was completely smooth, my midwife, husband, doula and I were all treated with dignity and respect, and everything went very well. This is how it's supposed to be: homebirths can and usually are very safe and successful for low risk women, but when things veer from "normal" the hospital is there. The author is absolutely correct that facilitating transfers will make things safer for everyone. My midwife didn't hesitate to transfer me because she wasn't afraid of how we'd be treated, and she's practicing legally in my state, which isn't the case everywhere. Heck, she even caught my baby (though not on purpose...my little one surprised us all!)

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Specializes in Community, OB, Nursery.

StudentAmie, this is why I strongly believe CPMs should be allowed to practice legally in every state - it pulls them out from 'underground.' My state is one of the few where it's illegal for them to practice, though I know they still do.

:twocents:

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StudentAmie, this is why I strongly believe CPMs should be allowed to practice legally in every state - it pulls them out from 'underground.' My state is one of the few where it's illegal for them to practice, though I know they still do.

:twocents:

Totally agree! No one should fear prosecution while doing what's right for a laboring mom and her baby.

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To be fair, maybe we should have a thread on "hospital birth gone awry."

Sometimes our interventions cause problems that would not have occured had the birth been at home.

Just because a problem happens in a home birth, doesn't mean the home birth shouldn't have happened.

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Specializes in L&D/Postpartum/Newborn, Home Health.

Beachmom, I could not agree more. I recall a situation where a physician sent a patient in for induction at 39 weeks, with an unfavorable cervix and when she was not progressing fast enough and had not delivered by lunchtime, the MD came in and put in an IUPC so we could increase the pitocin (she ordered to go to a max of "whatever it takes to get her cervix changing") she ended up putting the IUPC through the placenta causing an abruption with massive bleeding and fetal bradycardia....during the emergency c-section she commented to the patient that she was "lucky" this happened in the hosptial and not at home-her baby would have died.....the patient then called all of her family after the c-section to sing praises to her hero the doctor that "saved" her baby.......FRUSTRATING!!!!!!!

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Specializes in Geriatrics, Home Health.
StudentAmie, this is why I strongly believe CPMs should be allowed to practice legally in every state - it pulls them out from 'underground.' My state is one of the few where it's illegal for them to practice, though I know they still do.

:twocents:

I think midwifery should be limited to advance practice RNs. CPM education varies widely. People often cite the Netherlands for good midwifery outcomes. Dutch midwives are required to have 3 years of university education.

The difference between a CPM and a Nurse Midwife is like the difference between a Registered Dietician and Nutritionist; Dieticians have degrees and pass a licensing exam, while anyone can call themselves a Nutritionist.

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Specializes in Emergency Department.
I think midwifery should be limited to advance practice RNs. CPM education varies widely. People often cite the Netherlands for good midwifery outcomes. Dutch midwives are required to have 3 years of university education.

If CPMs were legal in all 50 states you might see the educational requirements elevated and uniform. Did you know the largest study to date on positive home birth outcomes was a result of data collected by CPMs? CNMs like it so much they cite it as if it were theirs.

The difference between a CPM and a Nurse Midwife is like the difference between a Registered Dietician and Nutritionist; Dieticians have degrees and pass a licensing exam, while anyone can call themselves a Nutritionist.
Um, no. Not just anyone can call themself a CPM. They have to meet a minimum educational standard, meet minimum clinical requirements, and pass a credentialing exam (which equates to the licensing exam in legal states). If they have graduated from an accredited midwifery program, they also have a degree. Like me.
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I feel like I had the best "between both worlds" experience with my labor/birth experiences. I have had four children in a small community hospital owned by a large corporation CHW. I had a midwife who delivered the last three. These three were water births. I was allowed to eat and drink freely during labor, though eating was discouraged later on in labor by my nurses. They checked me with a 20 minute strip upon admission and after 4 cm when I got into the tub I was checked with an underwater "dopplar"? the hear the baby's HR. The water took about 80% of my pain away as soon as I got in. It helped my pain management a great deal.

Interestingly enough, the larger CHW hospital closer to where I live does IV on admission, almost continuous monitoring, no eating, and a high rate of C-sections. Many of my nurses during my labor/deliveries stated that they moved to the smaller hospital because they did not like the large busy hospital feel of larger OB unit. Just interesting.

I had thought about having a home birth for the natural choices, but I was glad that I had the opportunity to have a safer birth with modern technology readily available without all my choices being taken away.

:)

I will be going into the second year of the RN program as an LVN, it will be interesting for me to see how OB is run at this larger hospital from a clinical perspective.

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I think midwifery should be limited to advance practice RNs. CPM education varies widely. People often cite the Netherlands for good midwifery outcomes. Dutch midwives are required to have 3 years of university education.

The difference between a CPM and a Nurse Midwife is like the difference between a Registered Dietician and Nutritionist; Dieticians have degrees and pass a licensing exam, while anyone can call themselves a Nutritionist.

CPMs actually take the exact same licensing exam as CNMs. So no, not anyone can call themself a CPM unless they do the education, apprenticeship, and pass the exam. In fact in my CNM program and in midwifery programs of other types that I am familiar with, the midwifery students actually get far MORE births and experience in OB than a family practice resident does in their residency.

People get all worked up about the "apprenticeship." What if we called it a "residency." Or let's call what doctors do an "apprenticeship." They're the same thing!

Everything from prescribing meds to ordering tests is totally different when dealing with a pregnant patient population. I do provide some primary care services and that is where my nursing comes in handy- albeit rusty because I was an OB nurse so I didn't even do a lot of primary care, I am having to reach back to nursing school for that. Perhaps and expanded primary care educational component for midwifery schools and the elimination of the nursing requirement would be more effective.

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Specializes in Emergency Department.
CPMs actually take the exact same licensing exam as CNMs.

No we don't. Similar in core educational points, but not the same test. If it were the same, we could petition the ACNM (ACMB) to certify us as Certified Midwives, their designation of non-nurse midwife.

People get all worked up about the "apprenticeship." What if we called it a "residency." Or let's call what doctors do an "apprenticeship." They're the same thing!

This is the analogy I use too.

Everything from prescribing meds to ordering tests is totally different when dealing with a pregnant patient population. I do provide some primary care services and that is where my nursing comes in handy- albeit rusty because I was an OB nurse so I didn't even do a lot of primary care, I am having to reach back to nursing school for that. Perhaps and expanded primary care educational component for midwifery schools and the elimination of the nursing requirement would be more effective.

That would be nice, but good luck convincing ACNM their Certified Midwife credential might actually be more effective ;)

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No we don't. Similar in core educational points, but not the same test. If it were the same, we could petition the ACNM (ACMB) to certify us as Certified Midwives, their designation of non-nurse midwife.

That would be nice, but good luck convincing ACNM their Certified Midwife credential might actually be more effective ;)

Sorry- I got it confused. It's the "Certified Midwife" exam that is exactly the same. I should really, really know the difference. I have heard the NARM is far more rigorous than the CNM exam but I don't want to put that to the test anytime soon :)

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