Problems with baby a MW couldn't handle at home?

[lacysmommy]

I know all the risks for mom with a homebirth that would be better taken care of in a hospital (placenta previa, abruption, cord prolapse, etc), but I don't know which situations for baby would be better handled in a hospital.

The reason I ask this is because DH and I were talking w/ some friends the other day who are NCBers, but only in the hospital because of a fear of something happening. I told the DH (I'll call him G) that I have a whole book of studies showing that the mortality rate is the same in hospital vs homebirth setting for moms with low risk factors (and I definately told them that morbidity is lower at home!). He said, what if baby comes out not breathing, and I knew that MW's carry oxygen and are certified in infant recussitation, same course doctors take. But he said something about heart failure and defibrulators, and my DH (a former EMT) said you can't use those on anyone under the age of 3 so it was a moot point anyway. G said, wouldn't they have special equipment at the hospital that they wouldn't be able to have at home or in an ambulance that would save some babies? I replied that sure there are things that could go wrong, but the chance is very remote, and there are risks that things could go wrong in the hospital that would never happen at home (such as infection, or injury due to bad hospital protocols for birth, for example).

But in reality, are there things that could go wrong with the baby that the MW couldn't handle that would have to be handled very quickly (so no time to transport)? I don't think I know of a single thing other than birth defects that aren't compatable with life outside the womb, which would have had the same result no matter where you give birth. They had a really bad hospital experience with their last baby (and I was there so I know this firsthand!) so my answers to his concerns may mean that they will end up with a HB for their next one-- she's not opposed to it so I'm pretty sure it would happen if he got on board.

[amyro]

Home birth midwives in general have neonatal resuscitation certification and carry oxygen to the home. (This is an appropriate question to ask any midwife you're thinking of having attend your birth). It's thankfully uncommon that babies are born not breathing, but it certainly happens. The vast majority of these babies will breathe with some tactile stimulation and/or a few puffs of oxygen, which are very easy to administer at home or a birth center.

A very small number of babies will need advanced life support, which includes chest compressions (your husband is right that you don't use defibrilators on babies) and sometimes medications administered through an endotracheal tube or an IV. Because this is so rare, although midwives are trained to perform these measures, the argument can be made that it would be done faster and more efficiently in a hospital setting where they encounter those problems more frequently (both because they take care of high risk patients and also because they cause some of those problems with all of the interventions.) BTW, the vast majority of babies who are going to require this level of care are premies or otherwise high risk, i.e., not candidates for home birth in the first place. In addition to this, you're correct that they majority of other newborn problems are going to be related to congenital defects, some of which are going to be incompatible with life. (and many of which can be diagnosed prenatally either because signs like the mom measuring abnormally small and/or because she had an ultrasound if she chooses to.)

The point that some people have difficulty understanding is that, while there are certain individual babies or mom's who may have a bad outcome in the home that would have been different in the hospital, overall, when you look at large populations of moms/babes, planned home birth is consistently found to be at least as safe for babies and safer for moms than hospital birth in all well designed studies. This is because the rare situation that is harder to deal with at home than in the hospital is outnumbered by the iatrogenic problems that you see frequently in hospitals (aka, those caused by interventions or hospitalization such as fetal distress and infection).

I hope this helps you and your friend!!

[alegna]

I know of no specific condition. I would check Henci Goer's Obstetric Myth vs. Research reality for stats.

-Angela

[AngelBee]

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[cathicog]

Midwives are trained to be able to help nearly any baby born. Being born in hospital increases the risk for the baby quite a bit, for the reasons you mentioned. But mw do carry O2,are NRP certified, and if the baby has a problem, then the mw recognises that and will transport the baby afterwards. I know a mw who helped a couple at home and the baby was born with sacrococcygeal Teratoma (which, on reading, is very rare). Baby was born fine,vaginally(mw did wonder what was holding the birth up, baby was born to his waist and seemed stuck, she helped him out), other than that, and they took him in and he had resection surgery done. He is fine now...and that is part of a midwife's training. You work with normal so much, you instantly know(and in some cases not instantly, but you know something isn't right, or the mom knows it) if something isn't right. And you take the baby in for evaluation, or if it is incompatible with life, you grieve right along with the parents. But that is after the mom is taken care of....

[eirual]

My husband was very concerned about having a home birth and even called it 'selfish' at first, but one point that my midwife raised that completely turned his view around was that you basically have 30 mins. to deal with the first sign of fetal destress, wether you're prepped in the ambulance or @ the hospital is no different, and on top of that, there aren't always doctors (or O.B.s that can do C-Sections) available at the hospital, it could just as easily be the case that a Dr. need to be called in. So even if you're at the hosp. you may still have to wait for a Dr. So whether it's you travelling or the Doc travelling, there's usually a respectable amount of time b/w destress and surgury regardless of where you are. But the odds are in your favor that you won't need any medical interventions, even more so in a home birth~ (:

[liseux]

I`ll just chime in since I had an emergency ambulance transfer. Its true that most things, esp. resusc can be handled at home.

If a baby still looks bad or has a low heart rate after oxygen is given, the baby will need to transfer. A mw can do everything a paramedic can do when it comes to stabilizing a baby, but a truly sick baby might need a blood transfusion or abx or something not available at home. Also, epinephrine shots straight into the heart, most mw`s do not carry these. I can imagine that if a baby was born with a severe blood incompatibility problem or a platelet disorder, that he would need to get to a NICU soon, but even those babies have some time before they need a transfusion. That`s all I can think of.

Also, blood incompatibilty babies or heart defect babies both need medical attention, they`re not the kind of situations you`d want to say, Oh, well, it wasn`t meant to be, because both problems usually result in a completely normal life for baby after some early intervention.

[Peppamint]

Originally Posted by amyro

Home birth midwives in general have neonatal resuscitation certification and carry oxygen to the home. (This is an appropriate question to ask any midwife you're thinking of having attend your birth). It's thankfully uncommon that babies are born not breathing, but it certainly happens. The vast majority of these babies will breathe with some tactile stimulation and/or a few puffs of oxygen, which are very easy to administer at home or a birth center.

And most midwives will wait to cut the cord unless you have a true issue with the cord being around the baby's neck too tightly to allow the baby to be full birthed etc whereas at the hospital many doctors cut the cord immediately.

So the fact that some babies are slow starters is sort of a moot point if you give the baby a chance to continue receiving oxygen through the cord (except in cases where my placenta was out two minutes after ds was born- but thankfully he cried/breathed right away so it wasn't an issue).