MRSA and Homebirth?

[bluesparks67]

Hello all-

This is my first post and I just need some advice/someone to talk to. I am 32 weeks pregnant with DD #2. Our family has battled MRSA for 4 years. Our infections used to be absolutely horrible, having to go to the surgeon to get them lanced, etc. After we went off antibiotics completely, the infections started getting less frequent and less severe. Yes, still there, but more manageable.

So, I was planning a birth center birth for this baby (was in the hospital with DD#1). My DH and I informed the birth center at the start of our care that we have dealt with recurrent MRSA infections. Well, my DD recently had another infection on her butt and I just asked her dr. to take a look at it at her 3 year old checkup. Well, she's our family doc and she called the birth center telling them about our DD and her infection. So at my appointment at the birth center just a few days ago, I was talked to about how they may not be able to let me birth there, and if I do there may be a lot of conditions, such as not allowing me to use the tub, using everything disposable, wearing masks throughout labor, etc.

The midwife admitted to me she doesn't really know about MRSA and has never really dealt with it before. Don't get me wrong, I do understand that it's scary, but they don't know about how it's spread, etc. The way I was talked to was just humiliating. I don't know why they are just bringing this up now when they've had my entire pregnancy to freak about it.

My DH and I don't know what to do. They may let us stay there, with stipulations, but I have been strongly considering homebirth now. I am afraid I will be too tense at the center about their phobia of me that I won't be able to relax. My concern now, also, is that I won't be able to find a homebirth midwife in our area who will come near my family once we tell them we are MRSA carriers. We take great measures to prevent spreading it (frequent and proper handwashing, if there is a sore, covered at all times and chaning bandages with gloves, 7th gen. disinfectant wipes in every room of the house and daily disinfecting of surfaces.)

Sorry this is so long, I just really feel crushed because I wanted a water birth at the birth center and now if I can't find a homebirth midwife, what do I do? I can't bear to be in the hospital again. Traumatic experience with DD#1. I welcome any advice, but please be gentle as I have been treated like a leper the past few days. Thanks.

[sosurreal09]

I would think a HB would be abetter option b/c the MW would need to be concerned about herself getting MRSA but not other patients KWIM? The MW can certainly use standard precautions and get those long gloves so you can still have a water birth.

Sorry they are freaking out! I'm sure it's mostly about liability and what not :/

[bluesparks67]

Anyone? Help, please. I just met with a home birth midwife who won't take us for home birth because of this. I do not want to be forced into going to a hospital. So discouraged right now.

[IdentityCrisisMama]

Oh, jeeze!  I'm so sorry, mama.  If I were you I would stay calm for a while.  Call all the HB midwives in your area but first maybe do some research about MRSA and birth.  Midwifery Today may have an article or two.  I'll check around and see what I can find...

[IdentityCrisisMama]

I did a super quick search and didn't see anything.  Maybe a MW on the boards has some suggestions.  I would also stop over to health and healing to see if maybe someone there is familiar with MRSA.  It may not be a bad idea to speak with an OB just to get the medical opinion on why you are being risked out of a birth center and HB.  On that thought, did you ask a lot of questions from your birth center MW and the HB MW who risked you out?  If not, totally call them back and talk and ask questions about specifically WHY they will not take you.  I think I would do that before calling another HB midwife.  Good luck, mama!  

[sosurreal09]

Well I was a CNA for 5 years and I do know MRSA has special precautions...which is *probably* why they risked you out. It is spreadable and any risk to another woman or child could be very problematic. Also with open wounds (a tear giving birth or something) it could easily spread...

[bluesparks67]

IdentityCrisisMama-

Thanks for looking, too. I was not able to find any real information about MRSA and homebirth, etc, after hours of googling. I did talk to them, and they are all afraid I am going to "contaminate" their equipment. I don't understand why this is a reason as it can't be spread just through my touching things with healthy skin (non-infected). And anyways, I would think they should be following standard procedures for disinfecting after any births they attend anyways. Which board would I go on where there may be some midwives to talk to? Thanks for your help.

[Breathless Wonder]

I feel awful for you.  They do know that there are plenty of asymptomatic carriers, don't they?  PLENTY of people who have it think it is just a spider bite.  NUMEROUS people carry it in their nasal passages, and never end up with a boil/abcess. 

I just don't get it.  At this time, the protocol is only to keep active infections covered, and to isolate people with active infections in the ER.  The recommendation for people that have had more than one infection, or in families where more than one person has had an infection, is for them to treat their nasal passages with an antibiotic swab until they are clear.  There is NO protocol for people who have had it, and do not have an active infection.  I mean seriously- they may have patients who have had MRSA who are wearing t-shirt, sleeveless shirts, shorts, skirts, etc. and sitting on and touching their equipment.  They have NO IDEA. 

[AbbieB]

I'd be seriously pissed at your family doc for doing that to you! It's not like YOU were getting treatment for an active infection.

What does the birth center suggest you do? Are they bouncing you to their back up docs at a local hospital? What would be the protocol the hospital would follow for this known infection? Can the back up doc discuss protocols with the birth center? Can you ask the back up docs for recommendations for other midwives?

Is this something that prophylactic antibiotics could help with? Could you do a nasal swab for active infection, kind of like a strep B swab, to put eveyone's mind at ease?

Is there concern for your baby being at risk for a life threatening infection caused by being exposed to your infection? What does the doc say?

Is there concern that you could develop a much more serious infection? What does the doc say?

If it was me, I would also be hesitant to birth with midwives that were fearful. Fear gets in the way of judgment. I think you are right to seek care from someone else. Can the birth center recommend other midwives to you?

[dogmom327]

Isn't that a HIPPA violation? Your family doc called the birth center to inform them about a condition your daughter had presented with? That's a violation of your daughter's medical privacy. It was none of the BC's business what is going on with her (strictly speaking). I would seriously consider reporting the doc. That was inappropriate at best.

[tiredmidwife]

When moms list the advantages of home and birth-center births, one of the things that comes up for lots of women is the avoidance of the sorts of infections that are so prevalent in hospitals. MRSA is a big one on that list. Hospitals have pretty extensive protocols in place to try and prevent MRSA from spreading -- much more involved than standard/universal precautions -- and STILL it spreads. That tells me that containing and controlling MRSA is not so easy. If your birth center midwives are figuring out (belatedly, it sounds like) that dealing with your MRSA is going to involve more than their standard precautions, maybe their conditions and stipulations aren't coming so much from fear or panic or prejudice or a concern about litigation (really, kind of a snotty comment by the previous poster); maybe they're worrying about how to take care of you and their other families, and how to keep their birth center clear of a bad infection.

You describe your family struggling for four years with MRSA infections -- some 'horrible" ones among them. That sounds like a pretty bad MRSA bug -- not the one that people carry with no knowledge or symptoms.

I'm sorry you're having to deal with the MRSA, and sorry that it's complicating your birth, but maybe your local home birth and birth center midwives are trying to do their imperfect best to protect their communities. How is that bad?

[bluesparks67]

I am pretty pissed at our family dr. for doing that- completely inappropriate and she didn't have my permission. We had our "appointment" at the Birth Center today (during which they never so much as asked or even said anything about the baby or checked on her) and were told we are no longer allowed to be there. And another hb midwife called to cancel our meeting because of this.

About the hospitals- there are extensive protocols, but often they are not followed. Prime example being when my husband was in isolation in a hospital last year because of an infection, and we had to remind the nurse to wear gloves, and put on a gown when she came into the room. These "protocols" are not being followed and it's not so much of MRSA being impossible to contain, but ignorant healthcare workers not adhering to basic protocols.

And yes, our infections were horrible at one point- the one where we did everything the ID doctor told us to and that's what landed my husband in the hospital near death. This is hardly an issue anymore; infections are very few and far between.

BreathlessWonder- thank you. I agree with everything you said. Funny thing is now today I was told during birth MRSA would spread from me sweating. Ha ha. This just goes to show that the people I have been worked with are very poorly educated about this.

Sorry, I am just so angry right now because I feel that the kind of birth I was dreaming of and hoping with all my heart for has just been torn away from me. I am basically forced into a hospital (where there's even more MRSA), and feel that I can't birth how I want to. I had a traumatic birth experience with my DD#1 and don't want to be in that place again and have regrets about this birth too.

[tiredmidwife]

Hard to know what your family doctor was thinking here, or what her responsibilities are. There are circumstances in which provider-to-provider communication is legally and ethically appropriate. But I have to say that, as a home birth midwife, I really count on honest, complete communication with my clients. You seem pissed that the doc told the midwives about your daughter's infection... But don't you think you had an obligation to tell the midwives about this yourself? An active MRSA infection in your household is certainly relevant to your care, right?

And again, you refer to a MRSA infection putting your husband in the hospital "near death." That is not your run-of-the-mill MRSA. I hear how much you want your birth the way you want it, but surely you also feel some responsibility for protecting other mothers and babies from the infections your family has had to suffer with, no? It's terrible that you're put in the position of thinking about that, but that's where you seem to be.

[tiredmidwife]

Breathless Wonder,

You're mistaken about the MRSA protocols for carriers who don't have active infections, at least when it comes to birth. Look up MRSA on labor and delivery -- it's a huge deal.

You say:

NUMEROUS people carry it in their nasal passages, and never end up with a boil/abcess. 

But Bluesparks has said that her family has had numerous infections, including a current one and past "horrible ones." 

You say:

I just don't get it. . . .I mean seriously- they may have patients who have had MRSA who are wearing t-shirt, sleeveless shirts, shorts, skirts, etc. and sitting on and touching their equipment.  They have NO IDEA. 

But birth is not just about sitting around with dry, intact skin showing, right? Blood, sweat, tears, mucus, feces, urine, vomit... I've seen it all, been splashed by it all, and had all of it get on my equipment at births (and I am careful, believe me). And I've never but never gotten through a water birth without getting wet... with water that has blood, urine, sweat, vaginal mucus, amniotic fluid, and sometimes feces in it. So... a little different from someone sitting in my office in her t-shirt.

I'm not really sure what birth centers and we home birth midwives can do/should do with known MRSA, but I am pretty sure that we shouldn't make light of it and blow it off. That's how the hospitals got into the trouble they're in.

[bluesparks67]

Ok, I am done here. I wanted some support/encouragement and TiredMidwife, this thread has taken an ugly turn. It's no longer helpful and I don't appreciate your comments.

[bluesparks67]

Ok, I am done here. I wanted some support/encouragement and TiredMidwife, this thread has taken an ugly turn. It's no longer helpful and I don't appreciate your comments.

[AbbieB]

OP, I'm sorry you feel attacked and are leaving the conversation. I had never heard of MRSA before and I'm finding this thread very enlightening.

I am concerned that you have been treated so callously by your midwives. Have they referred you to someone else for care, someone that will be able to provide care? 32 weeks is a terrible time to just drop someone. I am under the impression that they are required legally and ethically to continue your care until you have been accepted by another care provider, which they are required to refer you to. It seems like this is medical abandonment.

I completely understand your frustration and overwhelming sadness at what is happening. You've just lost your shot at an out-of-hospital birth. You say that you don't want to repeat your experience at the last hospital, is there another hospital you can go to? Can you find a different health care provider than last time with privileges at another hospital, even if it's further away that you had planned? It does make a difference which hospital you use.

[Cynthia Mosher]

bluespark67 I can appreciate that the info tiredmidwife gave is not quite what you were looking for but I don't think it is "ugly". She's concerned about your safety and the safety of your unborn child as well as your entire family. It's always good to hear all sides of information and ideas so that you can make informed choices. I would discuss MRSA and the potential concerns regarding homebirth with a health care provider you trust and respect. 

[tiredmidwife]

Bluesparks67,

Don't know if you're still here, but I want to apologize if there was anything in my tone that came across as "ugly." That was certainly no part of the energy I felt when I wrote it, but I recognize that it's hard to control tone in email, especially when the subject is difficult.

Your initial post asked for advice about an upsetting and complicated situation. I'm a regular reader of these forums, but I haven't posted before. I joined and posted to respond to your request, and I tried to do that in a careful way. I think my tone was pretty respectful, Bluesparks, but it's true that I didn't rush in to reassure you that your MRSA is no big deal, and that your midwives are clearly in the wrong here. At the risk of upsetting you again, I have to wonder whether in this case "ugly" just means "not what I wanted to hear." The hard truth is that there sometimes are reasons to advise birth in a hospital, even when a woman passionately wants something else. As I said earlier, I'm not entirely sure what we in the out-of-hospital birth community need to be doing with and for families with bad MRSA histories, but I do think it's complicated, and I think it's a big deal -- which your own family's experience makes really clear, right?

It's a bit off topic (and I apologize for that), but I have to say, too, that I've been a bit taken aback by how quick so many of the responders in this thread have been to judge and condemn your midwives -- they've been described as callous, ignorant, concerned only about liability, treating you so badly, etc. And all of that judgement is based only your very angry (your words) accounts.  When you then characterize my own very careful response to you as "ugly" it makes me wonder about your characterization of the midwives at your birth center.

I'm sorry for the difficulty of your situation Bluesparks; I really am. It's a very hard place to be in. I agree with Cynthia's suggestion that you talk this over with a healthcare provider you trust. And if there are other midwives out there with more wisdom and experience on this topic, I'd be really interested to hear from you.

[KellyinABQ]

Where are you located?