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Apgar Score of Zero at Five Minutes - Page 7

post #121 of 129

Yes, she realize she had misread it and that it's 5 minute.  


I know y'all were wanting mw's to weigh in, that's why I shared it.  Here's a comment from another:



There is a difference in rate of successful resuscitation of 'dead or nearly dead" babies between hospital vs home birth -undoubtedly because of the higher technology available in hospital which can create a response even in dire circumstances.  There is not however - at least according to the Wax study -- a difference in longer outcome...sometimes a hospital can keep a baby going a lot longer on machines -- when at home the parents would have elected to give up.
I can certainly understand why a home birthed baby would have less of a chance with an Apgar of 0 at five minutes than a hospital birthed baby under the same circumstances. There are lots of bells and whistles available and loads of personnel at a hospital birth who would snap into action with a one minute Apgar of 0, and to reach five minutes and still be 0 despite all the interventions would certainly indicate a dire situation.
post #122 of 129

"It's already been said, but bears repeating, that HB is NOT restricted to low risk mothers in the U.S. (and Oz, and I am sure other first world countries as well)."


But such high risk mothers have to find midwives willing to attend them.  So does HB have worse outcomes in the US and Oz because of a failure of midwives to appropriately recognize risk?  Because of a failure of midwives to provide appropriate informed consent? 

post #123 of 129
Originally Posted by MeepyCat View Post

Salr, my take on it is angled just slightly differently then the one you're talking about, and I feel it's worth explaining.


I support the right of women to birth at home, with or without midwives, as they, individually, see fit.  The pregnant women are the ones with rights in this situation.


I support the requirement that midwives honestly discuss risks with their clients.

I support legal limits on the scope of practice for midwives, so that if a home birth presents risks above a certain level, the midwife not be permitted to charge for her services as midwife.  (I would support a midwife charging for her services as a doula in this situation, either as a doula for a hospital birth or a doula under a midwife with more extensive training.  I would not support a midwife saying, basically, "home birth is really risky for you because of X, Y and Z issues that I lack the training or equipment to handle safely, but if you really want, I will bill you and attend your birth at your home, even though we have good reason to expect it to be a disaster.")

I support nationwide licensure for midwives, with uniform standards, and requirements for continuing professional education.

I understand my view may be skewed since it is based on the one particular practice I have worked with and what I have heard about other practices in the area, however, I feel like it is the standard for most certified midwives to be open about the risks involved and to encourage or even require that a mother with risk factors transfer care if they fall into a category determined to be too high-risk. I was told at my initial consultation before opting into care that there were several scenarios that might place me at too much of a risk for my midwife to continue my care. I was informed of what would require that I get additional medical assistance in pregnancy and be approved to still use the midwife for delivery (such as gestational diabetes), and after my delivery, when my placenta was a bit slow in delivering (40 minutes), we had already begun discussing protocol, which would have been for the midwife to recommend a hospital transfer at 45 minutes and require one at 1 hour.


I have read horrible stories about midwives who kept insisting everything was under control when the mother began asking if a hospital transfer might be better. In the case of my midwife, had I begun to have doubts for any reason, even just that I personally wanted pain meds, a transfer would never have been an issue and I would have been free to make that decision with their assistance in the transfer.


I do agree that nationwide licensure and uniform standards could help to ensure that midwives are providing the proper care within the scope of their abilities and for the women who are interested in the options provided and for whom home birth offers a minimal level of risk.

post #124 of 129

The OB/GYN interviewed in this video about homebirth tragedies refers in places to these statistics (and others) regarding negative outcomes by home-birth midwives. At the same time, she places a high level of regard with CNMs (pointing out, from these statistics, that the very best birth outcomes are those with a CNM), while also blatantly ignoring the fact that one of the women sharing her story indicates that of the three attending her birth, two were actually CNMs who falsified the paperwork they turned in regarding her birth.




I feel like this video is a loud cry for some type of standardized certification for homebirth midwives so that they can practice, openly, once they meet standards to be credentialed. It should also be a wake-up call, not against homebirth, per-se (FTR, I am very pro-homebirth); but rather, for women who wish to have a home-birth to trust their instincts. In both of these cases (and in every case I have read about regarding negative home-birth outcomes), the mother had some cause for question or concern before the point at which it was too late for them or their child to receive adequate care. Just as I would encourage a mother who is not satisfied with the answers given by their OB/GYN about interventions to seek a second opinion; I would encourage a mother who is not satisfied that an midwife's assessment of risk seek the second opinion of a trained medical professional regarding their care.


I feel that the OB/GYNs statistics (and omission that two of the midwives in this case were in the CNM category), also calls into question this type of study. In the one particular case, the mother clearly states that the CNMs did turn in information on the birth to the hospital, and that they falsified the information (stating that she had declined a suggested transfer, when instead she had asked before the midwives arrived at her home and was assured that her planned breech delivery at home would be safe). She also says that when she attempted to sue (her case was thrown out), she discovered that the team had a history of negative outcomes as well as negative outcomes following her own delivery. And also, since there is such a varied standard for CPMs (with some states requiring licensing/some not/some not recognizing CPMs at all), I question what standard is being used to determine the level of care for home-birth outcomes, as well.

Edited by JenVose - 8/2/13 at 11:46am
post #125 of 129

The woman in the video who had the baby that died after CNMs told her a vag breech was safe, is Sara Snyder. She runs the Safer Midwifery for Michigan sites (blog, FB page, etc.) and has posted some articles about finding a safe midwife and talking responsibility for the safety of your birth. Part one was about prenatal care and labor, but I think they planning a second in that series regarding postpartum and newborn warning signs.


I do not think parents are encouraged to balance their education about home birth. There are too many stories here and on other sites, including MDC's Birth Trauma forum where women are told that much of what are in reality danger signs, are "just variations of normal".  Women are not encouraged to educate themselves about the warning signs and signs that mom or baby are in trouble. I suppose that most assume this is knowledge that the midwife has and will act on as needed, but as you point out either the midwife doesn't know, or she chooses to ignore those signs, and mom and/or baby suffer as a result.

If women are going to educate themselves about birth OOH to avoid situations where baby ends up with an Apgar score of "0" at 5 minutes, then they should also know about the signs of danger and can act in their own best interest or in the interest of the child.


Prepare for a lovely home birth, but also prepare to take action and trust your instincts.

"Take Responsibility for Your Pregnancy and Birth"  from Safer Midwifery for Michigan

post #126 of 129
Originally Posted by cynthiamoon View Post

This is the most important part of this study for me:

"Physicians also have the professional responsibility to address the root cause of patients’ motivations for out-of-hospital delivery through continuous efforts to address patient concerns about interventions, and to improve compassionate and safe care of pregnant, fetal, and neonatal patients in the hospital setting." 

Personally, home vs. hospital wouldn't be nearly as big of a debate if hospitals were better places in which to give birth. Out of my real life friends, those of us who care about natural birth, skin to skin, etc. don't really care where it happens as long as we are with trusted caregivers. It's just that "the hospital" is not often enough one of those safe places. 
Originally Posted by Jennyanydots View Post

I'm following this discussion with interest. Currently 28 weeks pregnant with my 4th and planning my 2nd homebirth (first two were born in hospital). I've been sitting on the fence about another HB this entire pregnancy. I agree completely with cynthiamoon about what drives many (including me) to seek OOH birth in the first place. I am very wary of having another hospital birth for fear that my wishes regarding treatment of the newborn will be ignored and met with resistance. My DD2 was vaccinated and given abx against my wishes in hospital, with the reasoning that because they couldn't find my medical records (I had preregistered with the hospital, THEY made a mistake) she needed to be treated as though I'd had no prenatal care and my demands were ignored. I remember all too well the hostile, disrespectful treatment we received.

Because of incompetent care by a MW (not my MW, but her back up) during my last delivery, I'm also wary of going the homebirth route this time. We switched to a different MW team, because although we thought our MW was great, she now practices with the MW we felt failed us. I am concerned because the nearest hospital that accepts HB transfers is about 20 min from us. Like Meepycat I've also had a chance to experience slow ambulance response times. When I miscarried last fall I hemorrhaged and my MW called 911 for me. The first responders were quick, but the ambulance took almost 30 minutes to get to my house. This leaves me with very little hope for a quick transfer should we need one.

I feel like my options aren't great. This study adds food for thought.

These two posts sum it all up for me. When I gave birth to my first, I was largely uninformed (I thought I was informed), and trusted my doctors. Because of this, I was completely taken advantage of, receiving THREE medications I did not need or want and which led to a very serious complication. When I developed an issue, I was misdiagnosed because no one would believe me when I told them what was wrong. I ended up with a c-section that may have been necessary right at that moment, but that was absolutely caused by the poor care I received. For my second birth, I was more informed. I tried to work with my care providers in an effort to seek evidence based care. In response, I was mocked for even having a birth plan, flat out told that I wasn't allowed to say no to an epidural, physically restrained and forced to give birth on my back, and told that I was incapable of giving birth vaginally. When I did give birth, the hospital staff tried to take my perfectly healthy son away by force (because, they said, they were too busy to let me keep him). I only kept my son by threatening to call the police, and even then they kept trying to take him away at every turn. A nurse even tried to sneak him out of the room while I was sleeping!

My only homebirth ended up being a serious emergency situation. It was a planned homebirth, but as it turned out, we didn't have a choice. My daughter, who was head down and completely fine the night before, ended up being born double footling breech in a 45 minute labor with a compressed cord. And 45 minutes is a generous estimate; I had barely even realized I was in labor when her legs suddenly popped out of me. I know that there was nothing that a doctor or planned hospital birth could have done to change things -- even the doctors who cared for my daughter afterwards told me so -- but it left me wondering what could happen next time. Something that could have been prevented? This study does nothing but provide a scientific basis for what was previously an emotional, unreliable gut-reaction. greensad.gif It leaves me feeling scared and angry. Women should not be forced to choose between neglect and abuse in the hospital, or statistically poorer outcomes at home.
post #127 of 129
Originally Posted by loveneverfails View Post


I would really love for Science and Sensibility or some of the other birth advocacy and education groups to look at this study and give their perspective.  All I'm hearing is silence, and the silence is damning.


Thought of this thread when seeing this today: 




Some good links in there too... though I wish they went into more depth... looking forward to the follow up they mention they'll put out.

post #128 of 129
Thread Starter 
Originally Posted by oceanmamafarmer View Post


Thought of this thread when seeing this today: 




Some good links in there too... though I wish they went into more depth... looking forward to the follow up they mention they'll put out.


Interesting. It's very interesting to me that Gordon says that birth certificates "are not very accurate when it comes to rare outcomes like very low Apgar scores, seizures, or deaths" and then references "Northam and Knapp, 2006" to back that up. When, actually, that Northam and Knapp article says the opposite. One of the comments below Gordon's article says this:

 The heart of Gordon's piece is this:

"What we know about using information drawn from birth certificates is that they are pretty good for capturing information about things like mother’s age and whether she is carrying twins. They are not very accurate when it comes to rare outcomes like very low Apgar scores, seizures, or deaths (Northam & Knapp, 2006)."

But the Northam & Knapp article, SPECIFICALLY says the OPPOSITE!

"Birthweight, Apgar score, and delivery method agreed 91.9% to 100%. The high-percent agreement supports the reliability of those variables …"

So the heart of Gordon’s argument is completely untrue. And Gordon referenced the mistruth with a citation that showed the opposite of what she claimed it showed.

Do you plan to correct that misinformation?


Gordon hasn't responded to it yet. 

post #129 of 129

Thanks for sharing that perspective too. I'll be interested to see what Gordon replies. I will say however, that I think it's a bit of a stretch to say that "the Northam & Knapp article, SPECIFICALLY says the OPPOSITE!" ...


This is from the abstract (I don't have access to the full text):



The reliability and validity of birth certificate data vary considerably by item. Insurance, birthweight, Apgar score, and delivery method are more reliable than prenatal visits, care, and maternal complications. Tobacco and alcohol use, obstetric procedures, and delivery events are unreliable. Birth certificates are not valid sources of information on tobacco and alcohol use, prenatal care, maternal risk, pregnancy complications, labor, and delivery.


Birth certificates are a key data source for identifying causes of increasing U.S. infant mortality but have serious reliability and validity problems. Nurses are with mothers and infants at birth, so they are in a unique position to improve data quality and spread the word about the importance of reliable and valid data. Recommendations to improve data are presented.



From my reading of this, their whole study found that birth certificates are NOT reliable data sources. Yes, some elements were more reliable than others, but on a whole they "have serious reliability and validity problems." To me, that negates the idea that they can be used legitimately as the sole source of information in a research study. Again, I don't have access to the full text, so I can't verify the percentages listed by the commenter, but even the abstract does count Apgar scores as one of the more reliable reported statistics. Even so, 5 minute Apgars of 0 are so rare that I would imagine that low Apgars at 5 minutes are NOT as reliably reported as Apgar scores on the whole (this is purely my own rational thinking). 

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