restore my faith in HB please

[harli]

Hi Mama's, My sister just had a baby in the hossy and had a lot of problems that are making me question our choice to HB our next child. I was more or less raped at my previous birth and the thought of walking into another hospital for delivery makes me terrified. I was looking forward to a HB but now I'm questioning it for two reasons....

1) My sister went into to deliver her first baby, she was with a midwife but ended up delivering with a natural birth friendly OB. Her labor was very fast at only 4 hours but there were a few complications. When she got to 9 cm's the doc told her to start pushing because baby's heart rate was dropping very badly (not sure how bad it really was since she was hooked up to an EFM). They tried a few different positions including squatting (for two pushes) and the baby didn't descend. The doc noticed that something was wrong, in that the baby was blue and told my sister that an episiotomy was necessary to get the baby out in time. He also told her that the baby had been mispositioned and the shoulder was stuck on her pelvis. He did the episiotomy and baby came right out. (which makes me question if there really was a shoulder dystocia because how could an episiotomy help that?) They left her attached to the umbilical cord but baby was blue and not responding and they had to cut in order to do CPR. After everything doc said that the reason for the problems was because the cord was wrapped around her neck and not allowing her to descend. Baby and Mom are now fine.

2) My MIL had 6 pregnancies. Her first birth was uneventful but then she had two consecutive stillborns(followed by 3 more healthy pregnancies). She had regular prenatal care, everything in the pregnancies was fine until it came time to deliver them and they were born dead. The reason she gives me is that the cord was wrapped around their necks. I realize that nuchal cords are very common but what are the chances that it killed 2 (almost 3 including my sis's baby) babies that I know of? I don't want to question my MIL about this because it would bring up sad emotions and I doubt she would remember (or understand) the medical jargon that she went through with them in the 70's. I realize there is probably more to this story but what other problems could it have been?

I guess my main fears is that how would a midwife handle these problems and how likely are they? Also any ideas on what really happened with my sis's birth? It seems to me there are some things that don't add up with that story.

[MommaKitten21]

Wow. I can understand why you would have some fears based off that information.


Both my babes were born at home. With ds, he was born completely blue/purple because the cord was wrapped around his neck two times. When I pushed out his head, DH yelled, "the cord is around his neck!!" (all panic stricken) and the midwife remained calm, and simply untangled it as I pushed out the body. ds was blue for quite some time, but with a little help he was perfectly fine. Never did I feel unsafe or as if something was seriously wrong during that whole time.

dd was just born a week ago... but no cord issues and no blue issues. She came out pink and plump, and very alert.

I would just make a list of your fears/concerns and ask your midwife how she would handle each one. Perhaps that would put your mind at ease more.

[artzy_fartzy68]

I would agree with the PP suggestion to ask your midwife how she would handle similar situations should they arise.

Not to questions your sister, and I certainly don't know her circumstances, but it's not likely the stillbirths were caused by cord issues. Many times it's not known what causes stillbirth and docs will sometimes suggest this as a "reason". Not that this is more of a comfort, I understand.

I've home and hospital births and only one of my 5 DIDNT have a "cord around the neck". None of the times was it a problem, at all! My last son had the cord wrapped around his neck AND his torso.

I know it's hard not to worry during pregnancy!
Hang in there, mama! I bet you'll have no trouble at all.

[harli]

Thanks ladies,

But just to clarify I'm not preggers yet but happily looking forward to another in the next year or two. Thus I don't yet have a MW otherwise I would ask her.

But honestly if I don't feel comfortable with HB I just may not want to have another baby. I had THAT bad of an experience at the hospital with my last and have no faith in ANY of the OB's in this area because of the very unethical things they seem so comfortable with. That said if I end up with a failed HB attempt and need to be transferred to the hospital at the last moment I think I might be able to be okay with that but the thought of going into a pregnancy knowing I will have to go to the hospital and deal with junky OB's for 40 weeks....well that is another story completely. Thus why I'm asking about this now before I get preggers again. I hope that makes sense.

[2ID_Wife]

You also have time since you aren't preg. I would start reading homebirth stories.
The epis could have helped since it gave more room, although I would bet some massaging and stretching by the midwife would work just as well. Also even thought it was quick being told the baby has to come now is stressful and can make it harder to push right and not fight it also. Being told it would help and she had it could have helped her relax some to push better too.

My only blue and quiet at birth baby that needed o2 and help did not have the cord around her neck(2 others of my 7 did), she just didn't have it in her to cry even when they started working on her failed both aparg(?). Both of the one with the cord around them had no issues at all from it.

[MammaB21]

I'm sorry your sister had a bad experience. It sounds to me like a lot of the panic could have been prevented. First off, it's quite normal for babies to be born blue. It takes a little while for them to oxygenate their blood. It can also take a little while for them to take a breath, which is usually fine as long as they're still attached to the cord. Blue is typically not an emergency, white or grey is cause for concern.

As for the shoulder dystocia, again, it doesn't sound like there was need for concern. In a true SD the head will come all the way out, but then the body won't come out with the next contraction because the shoulder is stuck behind the pubic bone. In a true SD there is only about a 5 minute window at that point to get baby out. The way a trained provider recognizes a SD is the 'suctioning' that happens after the head is born. The head will actually look to be being sucked back in. At that point, the best thing to do is to get mom to change positions. If she's not already she should get up onto her hands and knees. Just doing that alone usually solves the issue and allows the baby to be born. If not, she should get on her back and hold her legs all the way back, seperating the pubic bones. Finally, the care provider can reach in and rotate the shoulder to get it unstuck and allow the baby to be born safely. All trained home birth midwives will be familiar with these techniques and should have experience using them. IMO midwives usually handle these 'emergencies' better than OB's or midwives in hospital. Sometimes because what turns into an emergency because of managed care never even occurs in a homebirth. For example, shoulder dystocia is much less likely to happen when the mom is free to labor in the position she instinctively goes to. Laying on your back is the WORST position when concerned with SD. That brings me to my next point of the doctor having her push in the squatting position for only 2 contractions. 2 contractions aren't enough to make an assessment about whether or not the position will help the baby descend. I'd like to know how many contractions she was pushing laying flat in bed? As for the episiotomy, they don't do anything when it comes to a SD. Shoulders don't get stuck on soft tissue, they get stuck on bone. It sounds to me like the doctor panicked and cut an epis without reason. In a hospital they have to prove they've done everything they can for the best outcome. Even though it is known in the medical community that an epis doesn't help SD, it is better for the DOCTOR to say they did one to prove they've done everything they can.

As for the baby getting CPR, do you know if they actually administered CPR? Because if they did, then I'd be inclined to say that something else may have been going on. There are different levels of resuscitation and CPR usually isn't used unless the babies heart rate is under 60bpm AND the bag of air hasn't done anything to improve the babies condition. So initially, they should have simply given the baby a little bit of room air if they thought the baby needed some extra help. Do you know what the apgar scores were at birth and at 5 minutes?

A cord around the neck typically doesn't cause this type of problem. Real issues with the cord are usually when the cord gets pinned between a shoulder and a pubic bone, or when there is a prolapse. I'm not a medical professional, and I can't argue that a cord around the neck is always %100 safe, but I do know that it's seen in about 1/3 of all births rarely resulting in any issues. Most times the baby can just be born 'through' the cord. If it's a little tight or short the midwife can simply unwrap it before the baby is fully born. It sounds to me that this doctor was reaching for something to justify his extreme actions in this birth.

[Mama Metis]

I agree that hearing exactly what a midwife would do if a particular complication arose might help you to feel more secure. It may also help you to realize that what a midwife might do at home in an extreme scenario may not differ all that much from what an OB could do in the hospital. In other words, if a serious issue arises during birth, a midwife has almost as much at her disposal as an OB in the hospital would, minus just a few things: she can't do a c-section, and she probably can't intubate the baby. But she can perform an episiotomy in the rare situation that it would be necessary, and she can resusitate/oxygenate the baby. It sounds like this is what the OB did in your sister's case.

Also, I know this is the homebirth forum, so I hope this isn't an unwelcome observation, BUT... I wouldn't rule out having children if it turns out homebirth isn't for you. That may be a decision you regret. There may be other options, e.g. birthcenter in or near a hospital, midwife-attended hospital birth, etc. that are right for you if homebirth is not.

[donutmolly]

I would be another to say that you can't really know what happened at those births -- often the stories that women get from the doctor are there to justify the "treatment" and to promote the importance of the doctor. That's why so many homebirthers hear the stories that end: "and if I hadn't been in the hospital, the baby would have died!"

In my case, I heard about my parent's neighbor who had an attempted HBA2C -- the story we heard was that because she was at home, her uterus ruptured and the baby died and she nearly did too... that was the only explanation our community needed about why the birth went wrong. Because there is a societal belief that birth is dangerous and therefore it must happen in a hospital.

When I was getting ready for my first HB, my midwife actually set me straight on what had happened with my neighbor (who I didn't know personally, as they had moved in after I left for college). Since the birth community in our state is very tight, my MW had heard the story from the neighbor's MW, and it had affected the way MW's practice in the state. Specifically, the neighbor's MW had been able to tell that something was wrong and that a transfer was needed. They sat in the ER of a local hosp. for 3 hours without attention, despite the state-certified MW insisting on her patient being seen ASAP. Finally, they left to go to another hosp. that they hoped would be more helpful, again they were made to wait, even though the MW was advocating for her patient, finally she was put in a room, but not attended by a Dr. until it was too late. By the time they took her to perform an emergency C, the baby was gone and mom had to have a hysterectomy. This was clearly a result not of the homebirth, but of the hospital punishing a HB client by not giving her treatment immediately upon transfer. The MW was certainly not at fault, nor was HB!

All that to say, that there is a specific bias in our culture to make birth seem dangerous and keep doctors as the saviors. I don't buy it! I've had 3 wonderful HB's and know dozens of other women who have been cared for by respectful MW's and have had successful, completely uncomplicated HB's.

[peainthepod]

Originally Posted by donutmolly

By the time they took her to perform an emergency C, the baby was gone and mom had to have a hysterectomy. This was clearly a result not of the homebirth, but of the hospital punishing a HB client by not giving her treatment immediately upon transfer. The MW was certainly not at fault, nor was HB!

Oh, that poor woman. When I interview midwives one of the first questions I ask is how welcome they are at the hospital to which we would have to transfer in case of emergency. Getting punished by self-righteous allopaths for attempting a natural birth at home is one of my worst fears.

Poor little babe.

[corrio]

I just had a home bith and the cord was around her neck 3 times.. I really wonder what would of happened in the hospital.. Where most likely I would of been pushing on my back.. Instead of the hands and knees / squat I did..

[bandgeek]

You know what? Sometimes bad things happen at homebirths. Bad things can also happen in the hospital and in birth centers. Birth in and of itself is risky to some degree. You have to look at it from every angle and try to decide what is best and safest for YOU and YOUR baby. In the end though, there are no guarantees. You just have to do what feels right.

I had a homebirth and my DD came out severely brain damaged. It happens. We don't know what caused it and for all we know, it could have happened prior to the birth. I have a friend who's baby died in the hospital because he went into distress and they refused to do a c-section. If he had lived, he would have been severely brain damaged too. Part of being a parent is accepting that you can't control everything or guarantee anything.

[harli]

I realize that bad things can happen in even the best of situations but I can't knowingly walk into a hospital/OB practice that seems to condone rape at birth. KWIM?

[bandgeek]

Originally Posted by harli

I realize that bad things can happen in even the best of situations but I can't knowingly walk into a hospital/OB practice that seems to condone rape at birth. KWIM?

Which is exactly why you have to do what's right for you and accept that no matter the choice you make, if something goes wrong, you did what you could to try to have a healthy baby. Some problems midwives are better at handling, some problems doctors are better at handling. You don't know what, if any, problems are going to crop up, so in many ways it's a crap shoot. I know that nothing different would have happened if my DD had been born in a hospital. I wonder what might have happened if my friend had been in a different situation. It's all speculation though.

[dannic]

Shauna, so sorry to hear of your loss. And the other mama's, how awful.

I agree that we all need to inform ourselves of the possibilities and then make the best decision we can, both with our hearts and our minds. Then, when sad things happen, at least we knew we did the best we could with the knowledge we had.

[MountainFamily]

i haven't had a chance to read all the replies, but cord issues are a common scape-goat for interventions. "we did xyz, the cord was around the neck, thank g*d we did xyz".

all 3 of my children have been born at home and all 3 of my children had the cord around their neck at least once. dc #2 had a true knot as well. they were all fine and my first 2 children started crying before their mouths were born completely.

umbilical cords are designed for compression, to get tangled etc. unfortunately, too many stillbirths and emergency c-secs/unnecessary interventions are blamed on cord accidents and cord problems. efm, pitocin, epidurals, lithotomy positions and the lack of one-on-one personal care from a hcp are the usual culprits in issues during labor/birth.

the data from around the world can't be denied: 94% of healthy women CAN and DO birth their babies drug-free and vaginally WITHOUT medical intervention. what is wrong with our american medical system is the MANAGEMENT of birth. research shows that interference and management of birth are the leading causes of maternal and fetal death, birth injury and traumatic birth in this country.

please watch Orgasmic Birth, The Business of Being Born, read The Thinking Woman's Guide To A Better Birth, Gentle Birth Gentle Mothering, Ina May's Guide to Childbirth. arm yourself with facts and knowledge. no study has ever shown that homebirth with a trained attendant is less safe than hospital birth. in fact, for a healthy woman, the data shows that homebirth is safer than hospital birth, as you avoid unnecessary interventions on you and your baby that could damage you, your baby, breastfeeding and bonding.

good luck on your journey and i hope that you find what you need to come to a peaceful place.

[laughingfox]

I'm no medical professional, but your sister's story sounds odd to me.
You said they tried different positions for pushing purposes, but did they try different positions for fetal heart rate purposes?
If a cord was tight around the neck, preventing descent, how would an episiotomy fix that? Same for the shoulder/pelvis issue. Episiotomy doesn't directly affect umbilical cord or bone placement.
I also have to wonder if her pushing was less effective simply because she was told to do it so soon.

Unfortunately, a doctor who is "natural birth friendly" is usually a doctor who says "I guess I'll allow you to try natural birth, if you insist. ", which is not the same as a doctor who's truly knowledgeable and supportive of natural birth.

I'm glad she and her baby are doing well!