Would love insight from homebirth midwives

[doulatara]

Thanks for reading and any input you could give me!:

I am a labor doula, and recently attended a really rough labor and birth. (Hospital birth.) To make a long story short, the mother had been induced in the late morning and we had been working through her contractions all day, she didn't have pain meds and was doing an amazing job. At about 9:30 p.m. after pushing for I believe just under two hours, she said that her vision was blurry. Because the room was dark other than a great big spotlight coming down from the ceiling on her, I told her to look away from the light for a moment and close her eyes. After several seconds she opened her eyes, I asked if she could see me clearly, and she said yes. About a minute later she started having seizures and she was wheeled away for an emergency c-section. Her last few readings for blood pressure were slightly high, but nothing too alarming. She had no indication that anything was going to go wrong until the blurry vision. It was a very alarming site to see, and the poor dad is still having a really hardtime dealing. Mom was in the ICU for a day after, baby was accidentally cut superficially during the section but both are healing and doing well now.

As for me, I am a huge believer in homebirth and a mother's ability to birth her baby safely. Don't get me wrong, I recognize the possibility that things can go wrong, but I guess usually I would think there would be some telltale signs before things would go down as they did.

I can't helping thinking of what could have happened if this was a homebirth...and my imagination is telling me that there is a good chance mom or baby would not be here today. I don't really know what I am asking for here. How would this have gone down if it was at home? I just really want to preserve my belief in homebirth...I just feel my confidence is shaken right now.

Thanks for reading.

[JunipersMom]

What was she induced with? What was the diagnosis - bleeding, eclampsia, rupture?

[jul511riv]

there would have been no induction in the first place. The seisures could have been stress from the induction (pitocin?)/pushing/ breathing issues or any other host of things that the hospital environment brought about.

[doulatara]

She was induced with pitocin.

I know there was talk of eclampsia while I was at the hospital with the family...but after talking to the mom extensively for the past few weeks, I asked if she ever had an official diagnosis and she said she wasn't sure. She told me she would definitely call her midwives to find out for sure. She did not however, ever get diagnosed with pre-eclampsia during pregnancy. She did have more swelling than most moms seem to...but no other symptoms that I knew of.

[SublimeBirthGirl]

It's hard to say what would have happened. When you start labor with something unnatural (induction), you throw off the entire process. Had she not been induced, perhaps things would have been different. That said, there are no guarantees in birth. Just death and taxes, eh?

[mamallama]

Originally Posted by doulatara

How would this have gone down if it was at home? I just really want to preserve my belief in homebirth...I just feel my confidence is shaken right now.

I'm not a midwife (just a burnt out doula)...but this topic really hits a nerve with me.

Like the pp have said, the induction may have been a factor. Or, this could have been one of those times when the fact of being in a hospital while giving birth saved that woman or her baby. Sometimes that happens.

Other times, the fact of being in a hospital while having an otherwise normal birth introduces complications (or pathogens) that end the life of the mother or the baby.

I hear what you're saying about fear, and I understand the sense of gratuity that emergency help was available when it was needed. I dig it.

But...(you knew this was coming) the thing is, as birth attendants we have to keep an eye on the big picture. It's faulty logic to make a generalization based on a single anecdote.

As far as how to keep emotions from clouding logic...I'll have to get back to you on that

[jengacnm]

Since when does pitocin cause seizures?

When I worked at a level III hospital, I remember a run of women with atypical presentations of preeclampsia/eclampsia/HELLP syndrome. One had a blood pressure of 90/50, NO edema,-and four beats of clonus and every subjective sign of preeclampsia (epigastric pain, right upper quad tenderness, headache, and visual disturbances). She got started on magnesium right away, mainly because just a few weeks before another woman had HELLP syndrome whose only presenting complaint was heartburn.

You've heard the saying, "when you hear hoofbeats, think horses, not zebras"? doulatara, you witnessed a zebra happen in front of you. It's possible to have an eclamptic seizure with very few signs of PRE eclampsia.

If at home, given an urban setting with a brisk EMS response time and a receptive receiving hospital with a call ahead report from the midwife, mom and baby would likely have lived and been ok-just taking a few years off the life of everyone involved.

One of a home birth midwife's responsibilities is knowing when someone is not a candidate for home birth. Another is handling emergencies until backup is procured. I certainly don't hope to see this at home anytime soon (or ever), but if I do, I'll have dad call 911, put oxygen on mom, try to support her so she doesn't hurt herself during the seizure, have my assistant monitor the baby's heartrate, and if the seizure stops, try to get an IV into her before EMS comes.

Birth can be trusted, but it should also be respected. Doulatara, you're normal to be shaken up. It may take a birth or two or ten before your confidence in birth is back, but the respect for birth that you got from this birth will probably stick around.

[mothercat]

Every rule has it's exceptions, and this was one of them. I agree with jengacnm about the unusual presentations. There are the "dry" eclamptics, who have a little rise in BP, but nothing all that concerning, and no other symptoms. There are the women who come into the hospital after a couple of hours easy labor and have a baby, then seize a few hours later on postpartum.

I have research job that is trying to figure out the why of these situations, but the answers are hard in coming. Unless she was on mag sulfate for seizure prophylaxis, I'm pretty sure that none of the staff saw this coming either.

[jul511riv]

I really like the last comment because this very obviously was something that nobody would have likely seen coming. Be that in a hospital or home or otherwise. The fact that you were in a hospital just made transport faster.

That being said, I do believe that pitocin could cause seisures. Could be an allergy. Could be a dosage issue. Could also be a very rare reaction, but I wouldn't rule it out. I also believe that the stress of having been under the influence of pitocin without any pain relief (remember, these are not "REAL" contractions, and are not likely the type of contractions that the body would produce on its own) or just the stress of the birth up until that point could have caused the seising as well. Does this woman have a history of seisures in the family? Fainting spells under particularly stressful situations?

Perhaps a slightly elevated blood pressure just is harder on her system than on average folk.

Either way, this is quite obviously a very rare situation that no one could have seen coming (had their been no clues in the case history, which obviously there sometimes aren't.)

This reminds me of an article I just read about HVP: http://www.telegraph.co.uk/news/main...-mostviewedbox

Obviously many people have one of the MANY MANY strands of HVP and this sort of thing is never even VAGUELY a concern. Perhaps nobody would have considered that this type of thing would have existed. But it's a rare thing that affects each person individually, like this particular man and can sometimes have rather weird and bizarre concequences.

[mountainmidwife]

Great answers so far.

I know a woman who seized due to pitocin....it was basically an overdose issue.

[mothercat]

I'm not sure that the term "Pitocin overdose" is quite the correct term. Pitocin has a an antidiuretic effect if used for over 24 hours in dilute form, such as induction.
It causes the body to retain fluid and results in too low of a sodium level (hyponatremia). I haven't seen it cause seizures but have seen two cases of congestive heart failure caused by it. That was pretty scarey but relatively easily corrected by some high dose Lasix.