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Friend's baby died...attempted homebirth then transfer :( Need some encouragement - Page 3

post #41 of 118

I have had 5 c-sections, all 100% necessary, all a very big deal to me, and I am so grateful that I live in a time and have resources to have had them. Never in a million years would I have hoped or expected this to be my birth experience, but it is. Just because a person has accepted the need for sections in some circumstances doesn't mean they believe them to be OK or no big deal.

post #42 of 118

I guess I believe there have been women who've said on this forum they'd rather their babies had died than have cesareans, if the PP has actually seen these posts.  But to me, that only signifies the soul destructive power of that operation.  Those women, were, I am very sure, in the depths of PTSD.  And of course I know very well there are women who can breeze into and out of the o.r. and proceed to "glow."  That is why elective c/s has become such big business.  Most experiences some find hideously traumatic will be a piece of cake for others.  So I guess the spider is a fair analogy.  But I personally prefer to compare it to having your legs amputated.  I'd do it if they were gangrened or crushed beyond repair, and it was the only way to save my life, but I wouldn't expect anyone afterwards to say, what are you whining about?  You're alive, aren't you?  The heart of this debate, I still believe, is the PROFOUND sorrow many women experience after c/s being minimized, dismissed, even ridiculed.  I think many of those posting just don't get this.  What difference does it make if it's abdominal or pelvic???  It is a callous attitude typical, I think, of doctors who do their work to save life and walk away.  It recalls to my mind how for many centuries no medical procedure could be done without causing pain.  (Even with opiates.)  Doctors learned to shut their ears to screams and pleading.  There was doctor who posted somewhere about working to save a woman who was severely ruptured.  Someone wrote back and asked if she'd even be able to carry another baby, and he said he didn't know and "didn't give a tweet."  Ugh.

post #43 of 118

Clarifying the difference between abdominal and pelvic surgery wasn't supposed to mean anything.

It was just (as I said) about the semantics.

 

I mentioned it because I believe that overall, people prefer to use the correct identifier, if they're aware of them, because it helps avoid confusions.

 

Also, I'm not dismissing the fact that some women will be find the experience of having a CS less than palatable or even traumatic. I just think that women ALSO need to be aware that its not traumatic for everyone, otherwise they might be so afraid of it, that they will hesitate to get one, even if its necessary to save the life of their kid.

 

I think people need to be aware that BOTH is possible: being traumatized / depressed by the experiene and being ok with the experience and that they need to factor that knowledge (and an assessment of how THEY are likely to react to such an event) into their decision making process.

post #44 of 118
Quote:
Originally Posted by Kanna View Post


If the baby is in SERIOUS mortal danger (like your friends' baby apparently was) the docs can do a crash cesarean (the rarest form of cesarean) which, from the decision to get the endangered kid out to acutally holding it and taking life-supporting measures if necessary, takes about 15 minutes, with about 5 minutes for the actual procedure.

 

I find it interesting that you resurrected this thread after over a year.  You must feel passionate about this topic.

 

I addressed the issue of "crash cesareans" in Post #8 of this thread.  Please read carefully the links that I provided. 

 

In light of this evidence, it would be disingenuous to scare women out of home birth based on the non-availability of "crash c-sections." 

post #45 of 118
Quote:
Originally Posted by Turquesa View Post



I find it interesting that you resurrected this thread after over a year.  You must feel passionate about this topic.

 

I addressed the issue of "crash cesareans" in Post #8 of this thread.  Please read carefully the links that I provided. 

 

In light of this evidence, it would be disingenuous to scare women out of home birth based on the non-availability of "crash c-sections." 



 

LOL. I'm new to mothering, so right now, I'm pretty much I'm bouncing a bit all over the place to get to know the site.

 

I'm glad that in case of emergency, c-sections are available, but as long as there is no emergency and no other medical condition that might seriously complicate a vaginal birth, then I firmly believe people SHOULDN'T have one.

C-sections is a subject I'm interested in, but I don't think I qualify as "passionate" about the subject.

 

As to post #8, well, I live in Germany, and here the recommended decision-to-incision time is 20 minutes and going by the post you linked ( http://www.obgmanagement.com/article_pages.asp?AID=4284 )  shorter decision-to-incision time are considered better by experts in cases of complication like major abruption or a cord prolapse, since they are associated with better newborn outcomes.

 

Some hospitals cannot achieve the 30 minute goal, but there are some hospitals that hold regular drills and change their procedures so that they DO achieve a decision-to-incision time of 15 minutes or less. Here's an example of a rural hospital that managed to improve their d-t-i time to about 20 minutes: http://www.ncbi.nlm.nih.gov/pubmed/17301207

 

Here in Germany, hospitals offer tours of the L&D department to expecting parents, and you can drill the docs, midwives, pediatricians and nurses to your hearts content about any worries you might have, including decision to incision time in case of emergency. Not sure if such tours are offered in the US, but hey, even if not, information like that should be available if you make inquiries with the head of the L&D department.

 

And yes, I AM  aware that a crash c-section is a lot more dangerous than a normal c-section. Still, faced with the imminent death of my kid and given a chance to save her life (even if it was risky) I wouldn't have hesitated a heartbeat to say "Yes" to a crash c-section.

 

As for hospitals not being always able to comply with the 30 minute ACOG recommendation: I have the feeling that, in case of an emergency occuring during a homebirth, adding transfer time on top of the decision-to-incision time is unlikely to improve the baby's chances of survival (or the mother's, if she's in danger too).

 

I don't feel that people should be "scared out of homebirths", but I had the feeling that, due to the baby of a friend dying during a homebirth, the OP was a bit on the fence about home- and hospital birth.

 

I find it helpful if in such a case people from either end of the debate share their experiences and the data they have come across. It enables the OP to examine a large range of information, and hopefully, it will facilitate their decision-making process. (After all, you're posting here too, no? wink1.gif ....and yeah, I know this post is one year old, but with a title like that, it is likely to attract the attention of people with a similar dilemma.)

 

As for me, I made the decision to give birth at a hospital. I had pit, an epidural (after I asked for it….never imagined being in pain could make you so TIRED), an episiotomy and they had to use a suction cup to get DD out, since she was BIG.

But I also had lots of calm and a nice birthing suite that contained everything from birthing balls to a nice soft birthing bed and muted lights, the department had a warm water tub to ease my contractions, lots of good counselling concerning bf, in-rooming with my kid….and the calm reassurance of the knowledge that if anything DID go wrong, I was as close as I could possibly get to the equipment and the trained professionals that would be able to save me and my DD's life. It made for a VERY relaxing and pleasant birth-experience.peace.gif

post #46 of 118

 

Quote:
Originally Posted by Kanna View Post



As to post #8, well, I live in Germany, and here the recommended decision-to-incision time is 20 minutes and going by the post you linked ( http://www.obgmanagement.com/article_pages.asp?AID=4284 )  shorter decision-to-incision time are considered better by experts in cases of complication like major abruption or a cord prolapse, since they are associated with better newborn outcomes.

 

Well, specifically, here is how the author worded it:

 

Quote:

 

These recommendations are based on the opinion of experts, not on prospective trials. Many authorities believe that in some clinical settings, such as with a major abruption or a cord prolapse, “decision-to-delivery” times in the 10- to 20-minute range are associated with better newborn outcomes than times in the 30- to 45-minute range.

 

The key words are "opinion" and "believe."  So even in the cases of abruption and a prolapsed cord (the latter of which could happen anywhere and at any time, regardless of the planned birth site), it is opinion, not science, that is guiding the 30-minute protocol, which has been contested multiple times:

 

http://cat.inist.fr/?aModele=afficheN&cpsidt=2714626

http://journals.lww.com/greenjournal/Abstract/2006/07000/Decision_to_Incision_Times_and_Maternal_and_Infant.4.aspx

http://onlinelibrary.wiley.com/doi/10.1002/jhrm.5600190105/abstract

 

As you can tell from the third link, this is a critical issue for obstetricians who fear being sued for not doing a cesarean "in time."

 

 

Quote:
Some hospitals cannot achieve the 30 minute goal, but there are some hospitals that hold regular drills and change their procedures so that they DO achieve a decision-to-incision time of 15 minutes or less. Here's an example of a rural hospital that managed to improve their d-t-i time to about 20 minutes: http://www.ncbi.nlm.nih.gov/pubmed/17301207

I'm familiar with this article, but it doesn't really establish the safety of a crash cesarean or prove that it results in better outcomes; it just assumes the crash cesarean goal as a "given."

 

Quote:
 

And yes, I AM  aware that a crash c-section is a lot more dangerous than a normal c-section. Still, faced with the imminent death of my kid and given a chance to save her life (even if it was risky) I wouldn't have hesitated a heartbeat to say "Yes" to a crash c-section

 

Well, since no scientific evidence has established better maternal or neonatal outcomes from a crash cesarean, how about a non-crash cesarean to save those lives?  wink1.gif  The issue isn't as black-and-white, either-or as dead baby v. crash cesarean. 

 

 

Quote:
As for hospitals not being always able to comply with the 30 minute ACOG recommendation: I have the feeling that, in case of an emergency occuring during a homebirth, adding transfer time on top of the decision-to-incision time is unlikely to improve the baby's chances of survival (or the mother's, if she's in danger too).

I don't know about any universal protocols among Certified Professional or Certified Nurse Midwives (any of you care to chime in here? winky.gif)  but with my out-of-hospital births, their protocol was to call the hospital and tell them that they were on their way over with a transfer.  This enabled staff to be ready for the woman when she walked (hobbled, waddled!) in the door.  It's not like it's medically necessary for her to lie there on site while people are assembling staff and equipment. 

 

 

Quote:

I'm also not sure what is universally recommended in terms of distance to the hospital, but I was 10 minutes away for my home birth and three blocks away for my birthing center birth.

 

and the calm reassurance of the knowledge that if anything DID go wrong, I was as close as I could possibly get to the equipment and the trained professionals that would be able to save me and my DD's life. It made for a VERY relaxing and pleasant birth-experience.peace.gif

 

I'm just curious....specifically which equipment do you have in mind? 

 

 

.

post #47 of 118
Quote:
Originally Posted by Turquesa View Post

 

 

Well, specifically, here is how the author worded it:

 

 

The key words are "opinion" and "believe."  So even in the cases of abruption and a prolapsed cord (the latter of which could happen anywhere and at any time, regardless of the planned birth site), it is opinion, not science, that is guiding the 30-minute protocol, which has been contested multiple times:

 

http://cat.inist.fr/?aModele=afficheN&cpsidt=2714626

http://journals.lww.com/greenjournal/Abstract/2006/07000/Decision_to_Incision_Times_and_Maternal_and_Infant.4.aspx

http://onlinelibrary.wiley.com/doi/10.1002/jhrm.5600190105/abstract

 

As you can tell from the third link, this is a critical issue for obstetricians who fear being sued for not doing a cesarean "in time."

 

 

I'm familiar with this article, but it doesn't really establish the safety of a crash cesarean or prove that it results in better outcomes; it just assumes the crash cesarean goal as a "given."

 

 

Well, since no scientific evidence has established better maternal or neonatal outcomes from a crash cesarean, how about a non-crash cesarean to save those lives?  wink1.gif  The issue isn't as black-and-white, either-or as dead baby v. crash cesarean. 

 

 

I don't know about any universal protocols among Certified Professional or Certified Nurse Midwives (any of you care to chime in here? winky.gif)  but with my out-of-hospital births, their protocol was to call the hospital and tell them that they were on their way over with a transfer.  This enabled staff to be ready for the woman when she walked (hobbled, waddled!) in the door.  It's not like it's medically necessary for her to lie there on site while people are assembling staff and equipment. 

 

 

 

I'm just curious....specifically which equipment do you have in mind? 

 

 

.




Hmm....granted, expert opinions only have an evidence level of III, while the studies you mentioned have an evidence level of II.

This time round though, it's something I am "on the fence" about.

 

The studies didn't find adverse effects in babies that got their c-section in a bit above 30 minutes. There is mention though of the fact that dwaddling isn't recommended either (Quote: "The authors conclude that specific high-risk factors do indeed warrant delivery in as expedient a fashion as possible"). Also, the studies are focused largely on fetal distress. What about uterine rupture? With something that's bleeding heavily, I think that a longer decision to incision time WOULD adversely affect the outcome.

And even you seem to agree (if I've read your post correctly) that in cases of emergencies like e.g. fetal distress a cesarean is recommedable (Quote: "...how about a non-crash cesarean to save those lives?").

 

The problem I see with transfer is not necessarily rooted in the organization between midwife and hospital. The problem I see is more banal: distance to the hospital and TRAFFIC. My mom died in the ambulance (not pregnant, she was sick), because the ambulance got stuck in a traffic accident. Not much chance of that kind of thing happening if the OR is just down the corridor. Also, I used to work as an EMT and boy, people can be majorly inconsiderate (or incompetent), blocking the road / street even though you've go your horn blaring and the blue lights flashing.

 

As for "equipment" I'd like very close to where I'm giving birth: an OR, equipped with a surgical team, an anaesthesiologist and a pediatrician, a ventilation machine usable for grown ups and one for neonates. An incubator. Defibrillation device. Ventilation masks. Desinfectant and sterile "blankets" to create an environment that is as aseptical as possible. A full pharmacy that has medication ranging from adrenaline to lidocaine. Feeding tubes. Sombody who will explain to a new mom and dad how to properly change nappies, even if it's 4 in the morning. A little room with comfortable, big chairs where new moms can come to nurse in peace and quiet and where the nurses are close at hand to help with any problems that might arise with breastfeeding, be it noon, 10 p.m. or 5 am. Breastpumps. Nappies and clothes. Ultrasound, i.v. fluids. A blood-bank. An NICU. A lab to check parameters from Hb to ph. Fetal heart-rate monitors. A well-run patient documentation system.

 

Yes, I know, this was a bit overkill. E.g. an NICU on site is not strictly necessary. But it made me feel safe and comfortable and the team (OB's and midwives both work together in the hospital here) was fantastic. And since my DD came down with an infection that could have evolved into full-blown neonatal sepsis, I was glad that the pediatricians did routine rounds on the newborns too, just in case. They caught the infection on time (thanks to the lab) and treated her for it, so everything was fine.

 

And the best thing? Nearly everybody in Germany has insurance, including me, so it didn't cost me a dime.

 

 

post #48 of 118

My baby died in the hospital, not a hospital transfer at all, as a result of malpractice. I had another baby end up with brain damage from bad medical care too. If something goes wrong, even if you are in the hospital, it is only a rare case situation where being there would have made a difference. This is because if it is so sudden that a transfer could not be done quick enough, then it was probably too sudden for the hospital to prep for a csect and have the baby in there, and also figure out something is wrong in the first place...etc. But starting out in the hospital to begin with can cause problems. My son who died from malpractice was because the OB made a mistake and induced me at 23 weeks. Found out years later, she was a repeat offender. Found out the very next day from when this happened that she meant to induce the woman in the room next to me but would not listen to me when I told her no. She gave me stadol to shut me up and then put the pitocin on. My son who has brain damage, I was induced because the OB was going out of town. It was my first baby and I did not know better. I was just excited to meet my baby. Instead, the baby was not in the right position. They refused me any sort of pain killers. I was pushing for 4.5 hrs passing meconium the entire time with the hospital refusing to do anything. It was a nightmare. He also did not live. I don't even know how he pulled through. In both cases, if only I had known, if only I had never been at the hospital. The one son would be with us right now (he should be 10 yrs old now) and the other would not have brain damage. 

 

Hospitals may have this feeling where we feel like because they are a hospital, and of course, TV and movies make hospitals out to be curing places and doctors are all Gods who only care about each and every patient. In reality, doctors, nurses, and everyone else there are just human beings, with their own lives and own opinions. And the hospital is just a very expensive building. And the medical staff is just as human and possibly even the guy who cut you off on the freeway. Seriously, you do not know them. You are just a job and a pay check to them. I am sure there are some out there that take their jobs more personally. But overall, there is just a mystique surrounding hospitals and doctors and such, but in reality, a lot of people die each year there. And there is only a rare case situation where actually being at the hospital during the birth would have changed the outcome. Yet, there are a lot of cases where having never been at the hospital would have improved the outcome.

post #49 of 118
Quote:
Originally Posted by Lisa1970 View Post

My baby died in the hospital, not a hospital transfer at all, as a result of malpractice. I had another baby end up with brain damage from bad medical care too. If something goes wrong, even if you are in the hospital, it is only a rare case situation where being there would have made a difference. This is because if it is so sudden that a transfer could not be done quick enough, then it was probably too sudden for the hospital to prep for a csect and have the baby in there, and also figure out something is wrong in the first place...etc........ 

 

 In reality, doctors, nurses, and everyone else there are just human beings, with their own lives and own opinions. And the hospital is just a very expensive building. .... Seriously, you do not know them. You are just a job and a pay check to them. ....But overall, there is just a mystique surrounding hospitals and doctors and such, but in reality, a lot of people die each year there. And there is only a rare case situation where actually being at the hospital during the birth would have changed the outcome. Yet, there are a lot of cases where having never been at the hospital would have improved the outcome.

 

First of all, I'm very sorry for your loss ands for the fact that your living child is brain damaged.

My daughter lives, but if ever anything should happen to her, I'm not sure if I would be able to go on. Just thinking about something happening to her hurts.

 

You have my heartfelt respect for being able to deal with the loss and to keep on building a life for yourself and your family.

 

Negligence, when it happens, is a terrible thing.

 

The crux is, it's not limited to doctors. Midwives can mess up just as bad. Here are some cases where midwives attending to mothers during a homebirth were the negligent ones:

 

http://hurtbyhomebirth.blogspot.com/

 

Here one from Oregon, just a few days ago: http://special.registerguard.com/web/opinion/26642904-47/midwives-birth-oregon-direct-entry.html.csp

 

Another few, seen from the legal perspective: http://www.slate.com/id/2293389/pagenum/all/#p2

 

 

Just like you regret your choice to give birth at a hospital, a lot of the baby loss moms in these cases regret giving birth at home with a midwife.

 

 

As for "doctors, nurses, and everyone else there (in the hospital) are just human beings, with their own lives and own opinions", yes, that's true. But it goes for homebirth midwives in exactly the same way, so I suspect it's not something that can be used as an argument for home- OR hospital birth.

 

And even if I'm "...just a job and a pay check to them." (regardless of whether "them" is doctors or midwives) why should that bother me? I'm "just a job and a paycheck" to my car-mechanic, my plumber and my hairdresser....all of which are professionals and have provided me with excellent service in the past.

 

Mind you, I've met quite a few doctors that DO care about their patients, their safety and their well-being. As far as I can tell, most med-students (and nurses) have a bit of a helpers' complex when they start their studies, and I should know, because I used to be one of them ^_~ Two of my best friends work as doctors at the hospital, and more than once, one of them lost a patient, simply because people were too sick to be healed, and after work, we'd talk on the phone because they needed to work through the grief of losing a patient without being able to help. (yeah, yeah, anecdata, I know, but this study ( http://www.ncbi.nlm.nih.gov/pubmed/18444436 suggest there might acutally be some truth to it)

I'm pretty certain the same is true for midwives, since as far as I'm aware a lot of people that choose careers in the medical or the social field have an altruistic streak. The approach is just different. 

 

Still, when push comes to shove, I don't expect my OB to pay attention to me beyond the medical stuff that he needs to know or to sit with me and listen to my woes when I'm having a bad day. I know the workload doctors have to deal with, which does not leave much time for niceties (Residents in the US work 80 hours a week and they often have shifts that are 30 hours in a row and its not that much better here in Germany). Basically, I expect my OB to be a professional who knows what he's doing and who acts with professional curtesy and care, nothing more, nothing less.

 

And if my doctor DOESN'T act like a professional, if he is negligent, and I (or my kid) came to harm because of that, then I wouldn't hesitate for a heartbeat to sue his pants off. I was quite amazed to find out that some people, who (admittedly, I'm guessing here) wouldn't hesitate to sue their doctor, seem to find the thought of suing a midwife for negligence abhorrent ( http://www.inservicetowomen.org/karen-carr/ ) .

 

Luckily, doctors CAN be sued if they are negligent. And they have to carry malpractice insurance, so the victims will at least get a financial recompensation (I hope you got a hefty sum for what happened to your kids. Taking care of a handicapped family member is expensive, and it's only fair if the one responsible pays for it).

Unfortunately, it's next to impossible to sue midwives in the US for damages, because they usually DON'T carry malpractice insurance ( http://www.jrlawfirm.com/library/texas-midwives-liability-insurance-dallas-medical-malpractice-attorney.cfm#top )

I think that's pretty unfair, especially to the parents.

 

Concerning your claim that "there is only a rare case situation where actually being at the hospital during the birth would have changed the outcome. Yet, there are a lot of cases where having never been at the hospital would have improved the outcome."

Uhm....could you maybe link to a study to substantiate that claim? I know that's only anecdata again, but the wife of a friend of mine would have died from blood-loss if she hadn't been at the hospital and I'm not sure if anybody would have caught on to my daughter's infection if we hadn't been at the hospital.

 

You also state that "....overall, there is just a mystique surrounding hospitals and doctors and such, but in reality, a lot of people die each year there."  Given that often people only go to the hospital because they are QUITE sick (heart-attack, stroke, cancer, pneumonia....), since lighter cases can be treated at home by the family physician and also given that dying at home when you're old has gone out of fashion in favour of dying at the hospital (which is quite regrettable, since as I take it, a lot of people would prefer dying at home, surrounded by their loved ones), I'm not surprised at all that a lot of people  die at the hospital each year.

People dying at the hospital doesn't mean that the care is lacking.....it only means that doctors often have the odds stacked against them where it comes to saving the lives of their patients (unless they work in departments like ophtalmology or ENT).

 

You also said that "....there is only a rare case situation where actually being at the hospital during the birth would have changed the outcome. Yet, there are a lot of cases where having never been at the hospital would have improved the outcome." 

 

Uhm, acutally, studies and statistics suggest otherwise. According to the data available, babies born at home carry a double to triple risk of dying compared to babies born at the hospital....which is acutally an outstanding compliment to hospitals, since midwives are supposed to take care of normal births and pregnacies while hospital get al lot more of the complicated and risky pregnancies and births too (gestational diabetes, preeclampsia, twins, BAC, breech, posterior presentation, anterior presentation, and transverse presentation...).

 

Take a look at Wisconsin, since they're pretty good at keeping their statistics up to date and they have a site where you can make queries with the data:

http://www.dhs.wisconsin.gov/wish/measures/inf_mort/long_form.html

change basic settings: neonatal mortality rate, step 3: all years, step 6: birth facility

Results: neonatal mortality rate
at the hospital: 4.55,
residence & other : above 10

 

Same thing goes for the data at the CDC: http://wonder.cdc.gov/lbd-current.html which is collected for the entire US.

 

Set the request form to

 

4. in the hospital

6. age of infant at death 1 hours / years = all years

 

Death rate / 1000 at

 

the hospital: 1

 

If you set the request at 6 to age of infant at death to "1-23 hours" the death rate per 1000 at the hospital is 1.71

 

Now, if you try the samt thing, but substitute " at the hospital" for "NOT in hospital"

you get a death rate per 1000

 

of 2.11 for children under 1 hour old and 3.44 for "1 to 23 hours old"



So basically, if you give birth at somewhere else than the hospital (e.g. at home), then the risk of your kid dying is HIGHER compared to giving birth at the hospital.

 

It's similar in other countries, e.g. the Netherlands:

 

Data on worse outcomes in births at home attended by midwives than in births at the hospital attended by OB's in the Netherlands: http://www.bmj.com/content/341/bmj.c5639.full.pdf

 

Giving birth at home DOES improve outcomes, according to the data available, at least if you measure outcomes by perinatal mortality from right after birth to 23 hours after birth.

 

 

 

 

post #50 of 118

Ah, the Wisconsin site is fun to play with. HOWEVER, if you make an adjustment to the way you were searching and also include "full term" in the search for births in residence, it drops the perinatal mortality rate to 3.19/1000. So, the much higher number you were quoting (which I never saw above 10 when I was playing with it, the highest I got was 6 point something) clearly involves unplanned homebirths with premature babies. Then, if you go back and add in the birth attendant and put "other midwife" (which I am assuming is their lumping of LMs and the more traditional midwives.... there are Amish community midwives in WI) then the rate goes down to 1.87/1000. Big, big, big difference from 1.87/1000 to >10/1000, wouldn't you say?

post #51 of 118

Hi sorry or barging in on this thread. I was doing a bit of lurking :$ forgive me..but I just want to say that a few days ago someone my family knew..their baby passed away while the mother was giving birth due to lack of oxygen to the baby while the mother was labouring..and this was in the hospital..the mom was in a coma as well..so I think both ways something can go wrong

post #52 of 118
Quote:
Originally Posted by marsbars View Post

Hi sorry or barging in on this thread. I was doing a bit of lurking :$ forgive me..but I just want to say that a few days ago someone my family knew..their baby passed away while the mother was giving birth due to lack of oxygen to the baby while the mother was labouring..and this was in the hospital..the mom was in a coma as well..so I think both ways something can go wrong



You're right. Kids and moms die at the hospital as well as during homebirth.

 

The trouble for an expecting mom, who, like all mothers, wants herself and her kid to be healthy and safe, is trying to figure out where both of them will be safer / less likely to come to harm....tea6.gif

 

P.S.: I'd say: lurkers welcome! The more, the merrier! smile.gif

post #53 of 118
Quote:
Originally Posted by MidwifeErika View Post

Ah, the Wisconsin site is fun to play with. HOWEVER, if you make an adjustment to the way you were searching and also include "full term" in the search for births in residence, it drops the perinatal mortality rate to 3.19/1000. So, the much higher number you were quoting (which I never saw above 10 when I was playing with it, the highest I got was 6 point something) clearly involves unplanned homebirths with premature babies. Then, if you go back and add in the birth attendant and put "other midwife" (which I am assuming is their lumping of LMs and the more traditional midwives.... there are Amish community midwives in WI) then the rate goes down to 1.87/1000. Big, big, big difference from 1.87/1000 to >10/1000, wouldn't you say?


You're right, including "full term" gives data that is more pertinent to the question!

 

I got to the higher number, because I added the 6.19 for birth location = residence to the 4.77 for birth location = other, since I figured "other" would include places like birthing centres, where births are also attended by midwives and not OB's. I couldn't find a definition for "other" on the Wisconsin website though, but if you know a place where they do mention it, that'd be really useful to nail things down better.

 

I'm not so sure about the definition of "other midwife". I suspect "other midwife" might be just CPM's while "other" probably includes unlicensed midwives (as far as I know, Wisconsin only started licensing in 2006, after a HB death that resulted in a lawsuit).

 

If for "all years" you use "full term", set the delivery method to "vaginal birth" (darn, should have included that in the earlier searches, since Midwives don't do C-sections) and then compare birth attendant = medical doctor and birth location = hospital (0.87) to location = residence & birth attendant = CNM + other midwife + other" (X (no data available?) + 1,96 + 4,92), so we can say for certain that the neonatal mortality IS double for homebirths with midwives (if midwife = "other midwife").

 

If we make the assumption that birth attendant = "other" equals mostly unlicensed midwives (and probably a few cases of freebirthing, intended and unintended) and that assumption would turn out to be correct....then the risks of giving birth at home would be truly bad, compared to hospital births (6.88 compared to 0.87 for OB/hospital births). That's about 8 times the risk. But unless we find the full definition for "other", we can't say that for certain.


Maybe I should also add that comparing "all years", "full term"

 

and delivery method "all" (so it's VB, VBACs, cesareans, forceps delivery and other) for birth attendant = medical doctor and birth location = hospital, you get a neonatal mortality of 1.12 per 1000 births.

 

to

 

delivery method "vaginal birth, no previous c-seciton", birth attendant = other midwife and birth location = residence, the neonatal mortality rises to 1.96 per 1000 births.

 

Given that "other midwives" usually get all the normal, non-risky births and pregnancies and doctors have to deal with all the risky, complication-riddled stuff on top of that, and doctors at the hospital STILL have lower neonatal mortality rates, then I think that's a darn fine compliment to the capabilities and competence of OB's and hosptital staff (even if midwives DO seem to have the better bedside manner....doctors could really learn from midwives in that department, I think).

 

 

 

 


Edited by Kanna - 8/8/11 at 4:23pm
post #54 of 118

Seems odd for someone to dig up an old thread on the homebirth forum and start pushing pushing pushing to prove that homebirth isn't safe.  And from what I see that site doesn't seem to include other risks of hospital birth aside from neonatal death, like say, maternal death.  Oh and lumping other locations in with your numbers is hardly accurate, as it's going to include unplanned births in cars and things like that. 

post #55 of 118
Quote:
Originally Posted by Paigekitten View Post

Seems odd for someone to dig up an old thread on the homebirth forum and start pushing pushing pushing to prove that homebirth isn't safe.  



Couldn't agree more. And if you look at her posting history, this isn't the only resurrected thread she's preaching her agenda on. 

post #56 of 118
Quote:
Originally Posted by Paigekitten View Post

Seems odd for someone to dig up an old thread on the homebirth forum and start pushing pushing pushing to prove that homebirth isn't safe.  And from what I see that site doesn't seem to include other risks of hospital birth aside from neonatal death, like say, maternal death.  Oh and lumping other locations in with your numbers is hardly accurate, as it's going to include unplanned births in cars and things like that. 



 Actually, I came across this thread while randomly browsing and since I gave birth just two years ago and had to make a decision on where to birth and thus understood the OP's dilemma a bit, I dropped by. What's odd about that?

 

Concerning maternal mortality in Wisconsin, here's a paper on the subject: http://www.hawaii.edu/hivandaids/Pregnancy-Assoc_Deaths_and_Preg-Related_Deaths_in_Wisconsin.pdf 

 

Leading cause of death were embolism and hemorrhage....both of which is something a midwife attending a homebirth would not be able to treat adequately.

 

Also,

 

a) the numbers of midwife attended HB are bad, compared to OB attended hospital birth, REGARDLESS of whether it's "residence" OR "residence" and "other"

 

b) women giving birth in the car, while they're on the way to the hospital, is a LOT rarer than TV shows would have you believe. Plus, you have to consider that of the women not giving birth at home OR at the hospital, a large percentage very likely DOES go to birthing centres. If moms where pushing out there kids in public parks, at Walmart, at Starbucks cafés and places like that in LARGE numbers, I figure it would be in the news.....winky.gif

 

 

post #57 of 118
Quote:
Originally Posted by LiLStar View Post





Couldn't agree more. And if you look at her posting history, this isn't the only resurrected thread she's preaching her agenda on. 


Uhmm....since when is being interested in a wide variety of subjects from wooden toys, vaxing, drinking water quality, birth, schools, missing breastfeeding, dealing with a kids temper tantrums and recommendations for good baby slings unusual for the mother of a two year old?

 

I share (which, btw. is a two way street....) my experiences and the information I have access to with other moms who are interested in the same things I am, but which might have different experiences and information so I can expand my horizons.

 

Sharing experience and information with others, especially if these aren't something we've run across before, is very important I feel, because ideas that have been put to the trial by others and withstood the test are something we can base the decisions in our lives on. This is, if I'm not mistaken, perfectly in accordance with the MDC guidelines that state that moms should come here "... with a desire to examine, discuss, and learn".

 

As for you accusing me of "...preaching an agenda", I'm a bit baffled. There have been other people here in this thread, engaging in a vivid and interesting discussion, adding there own to cents from the other side of the spectrum, with lots of links to information they felt supported their viewpoint (e.g. Turquesa or MidwifeErika), and I don't see you accusing them of "....preaching an agenda".

 

Don't you think that's a bit of a double-standard on your part?

 

In addition to all that, I believe that MDC guidlines state that posts should be "respectful, and courteous".

 

And somehow, I think that you and Paigekitten barging in here only to accuse me of "...preachin an agenda" does NOT fall under the heading of "respectful and courteous".....tiphat.gif

 

post #58 of 118

Kanna, I can't keep up with your posts!  I'll try to respond to your points, but there's so many that I hope you understand if I don't address every last one of them.  Here is my response and no mas for today.  redface.gif

 

 

 

Quote:
The crux is, it's not limited to doctors. Midwives can mess up just as bad.

 

 

It’s funny….everytime somebody here makes the factual statement that babies die in hospitals as well as at home, they get jumped on for lacking compassion.  I don’t think they do, and I don’t think you do.  Yes, agreed.  Babies die at home, babies die in hospitals. 

 

 

Quote:
The studies didn't find adverse effects in babies that got their c-section in a bit above 30 minutes. There is mention though of the fact that dwaddling isn't recommended either (Quote: "The authors conclude that specific high-risk factors do indeed warrant delivery in as expedient a fashion as possible"). Also, the studies are focused largely on fetal distress. What about uterine rupture? With something that's bleeding heavily, I think that a longer decision to incision time WOULD adversely affect the outcome.

 

Very true.  But there’s no proof that 15 minutes is something to brag about.

 

I’m wondering….why perform an intervention (crash cesarean, in this case) with much proven harm and very few proven benefits?  As a physician, you will have an ethical obligation to provide evidence-based care in which, quantitatively speaking, benefits outweigh risks.  Based on the available evidence, a fifteen-minute decision-to-incision crash cesarean doesn’t seem to fit this criteria.

 

Quote:
And even you seem to agree (if I've read your post correctly) that in cases of emergencies like e.g. fetal distress a cesarean is recommedable (Quote: "...how about a non-crash cesarean to save those lives?").

 

Agreed.  In cases of CONFIRMED fetal distress, (i.e. verified through auscultation and not just determined by electronic fetal monitor), a cesarean is necessary and saves lives

 

 

Quote:

The problem I see with transfer is not necessarily rooted in the organization between midwife and hospital. The problem I see is more banal: distance to the hospital and TRAFFIC. My mom died in the ambulance (not pregnant, she was sick), because the ambulance got stuck in a traffic accident. Not much chance of that kind of thing happening if the OR is just down the corridor.

 

 

First of all, my condolences for your mother. 

 

As Lisa mentioned, being in a hospital is no guarantee, and by your reasoning, shouldn’t we all just make hospitals our permanent residence?  You never know when something could go wrong, right?  And you wouldn’t have to worry about the traffic….

 

The slippery slope to this line of reasoning CAN go a little far if we're not careful enough to reign it in. 

 

 

Quote:
As for "equipment" I'd like very close to where I'm giving birth: an OR, equipped with a surgical team, an anaesthesiologist and a pediatrician, a ventilation machine usable for grown ups and one for neonates. An incubator. Defibrillation device. Ventilation masks. Desinfectant and sterile "blankets" to create an environment that is as aseptical as possible. A full pharmacy that has medication ranging from adrenaline to lidocaine. Feeding tubes. Sombody who will explain to a new mom and dad how to properly change nappies, even if it's 4 in the morning. A little room with comfortable, big chairs where new moms can come to nurse in peace and quiet and where the nurses are close at hand to help with any problems that might arise with breastfeeding, be it noon, 10 p.m. or 5 am. Breastpumps. Nappies and clothes. Ultrasound, i.v. fluids. A blood-bank. An NICU. A lab to check parameters from Hb to ph. Fetal heart-rate monitors. A well-run patient documentation system.

 

 

So how many of these do you think that my midwives may have had? 

 

I don’t know what your understanding is of midwifery care in the U.S., but my CPM/CNM team carried all of the equipment necessary for urgent and immediate situations.  They monitored my baby by auscultation (more accurate and evidence-based that EFM), carried drugs such as anti-hemorrhaging agents (which I did end up needing), neonatal rescucitation equipment (which I also ended up needing with my first), I.V. fluids (used with my first),  and AED. 

 

The rest, as you admitted, is overkill.  BUT I will say that if it makes you feel psychologically comfortable to have those on hand, it’s definitely your right.  And I hope that when you are a physician, you advocate for the reforms necessary to improve maternity care (unless it’s not nearly as abysmal in Germany as it is in the U.S.)

 

If you’re looking for sterility, however, you’d be a great homebirth candidate. ;-)  My MW’s were meticulously clean, and I got to avoid the very real danger of hospital-acquired infection.  http://www.safepatientproject.org/content_type/state_disclosure_report/

 

Oh, and you may be delighted to learn that my MW and her apprentice were available at all hours to demonstrate breastfeeding and nappy changes.  Both the birthing center and my home were equipped with those big, comfortable chairs, and I had round-the-clock breastfeeding advice. 

 

Some of the other amenities that you name are personal preferences and not necessarily life-saving (MANY U.S. hospitals don’t have NICU onsite but still have maternity departments).

 

Unfortunately, in the U.S., we have a strong movement of doctors and their supporters trying to dictate women’s birthing choices in part by fighting against licensure for midwives.  Without licensure, MWs can’t carry this equipment.  So women are either manipulated/coerced into hospitals, or they end up choosing the more dangerous situation of  ill-equipped and unregulated midwives.

 

Finally, my MWs worked with an AWESOME back-up doctor.  You see, not all doctors are in agreement, and this one totally supported women’s autonomy and the option of homebirth for low-risk women. 

 

 

 

 

 

post #59 of 118

A few things:

*Other for attendant is not unlicensed midwife, they would be listed under "other midwife". The license was not available until the middle of 2007. The act passed in 2006 and honestly was in the works LONG before the poor outcome that you mention.... that was not the reason for the license coming about. The license came about because midwives pushed for it to be available. So, anyhow, "other midwife" is the category that lists anyone who checks the box on the birth certificate that they are a non-CNM midwife this absolutely, for sure, includes non-licesned/non-CPM midwives. One does not have to be licensed to check that box or be a CPM (I have filed Wisconsin birth certificates) So, "other" could be a friend or partner or complete stranger. It could be the taxi cab driver bringing a woman to the hospital.

 

For location, "other" would include babies born in the car, along the highway, in a shopping mall, a girl having a baby in her high school bathroom stall, etc. It would not be a safe assumption that all these births were in the few birth centers and clinics that do births in the state.

 

Another point is that you would not add the numbers together, you would average them. So, if one group has a rate of 6.something and another has 4.something you cannot add those together and get a higher rate yet out of 1000 births. That would be your rate for 2000 births so then you would need to divide it by 2. Or, the most accurate rate would be to add and divide them up based on the actual numbers of births that happened in each location to get to 100%..... not sure if I am making total sense here as I am getting a bit sleepy. Anyhow, sorry, your math is just wrong.

 

post #60 of 118

Two other thoughts:

 

1. You're speculating on the meaning of "other midwife."  Why don't you contact the health department and ask for clarification. Perhaps they have an email?  I don't think it's fair to make such an accusation against Certified Professional Midwives until you are 100% certain that they are the sole group represented in "other midwife."  Honestly, I think it would make more sense if the "other" category pertained to planned and unplanned unassisted births, taxi cab births, etc.

 

ETA: I cross-posted on this issue with MW Erika.  Ooooooops!  redface.gif

 

2. The Homebirth Forum on MDC used to be a place where women found refuge in the non-judgmental company of like-minded moms.  They would come here to support each other and answer each others' questions (e.g. birthing pool or no?  What to do with older siblings?)  This was not the place where people questioned or debated their decision to have their babies at home.   

Frankly--and I know I'm in the minority here--I miss that format.  That's not to say that I'm against debating the home birth issue; I do it all of the time, especially on websites with the right context for it. 

 

But some of the frustration coming from other posters could be over how this forum has gotten so debate-dominated when that didn't use to be the case.  A number of anti-homebirthers have migrated over here.  That's nothing new.  I've also seen pro-vax doctors post on the vaccination board, for example.  I don't know what it is about this site or the Natural Family Living lifestyle...perhaps it threatens those who don't espouse it.  Whatever the reason, there seems to be a missionary-like drive among some individuals to preach to us, convert us, change us, fix us....

 

That may explain why some of us regulars are feeling on edge lately.  loveeyes.gif

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