Home birth advocacy in the face of death

April 2, 2012 · 36 comments

tragic death and home birth

tragic death and home birth

In the recent months*, I’ve heard of three midwife-attended, home birth deaths of newborns involving people I know. As you can imagine, it is heartbreaking.

I’ve cried and cried for the mothers and the children and the midwives. I asked God how He could allow this to happen to people I know and love. And I had to ask myself what I was doing as a home birth advocate. Was it still the right thing to do? What if someone read my blog, and decided to have a home birth, and their baby died? Would I know? Could I live with myself?

I don’t know anyone who has lost a baby in the hospital. I heard of one story a long time ago, the friend of the receptionist at my dentist. But now I know of four babies who died after home birth. One I know no details about, one had nothing to do with the baby being born at home, one likely would have been prevented with a hospital birth but was not due to negligence of the midwife, and one was a direct result of midwife negligence.

As a midwife and home birth advocate, what am I to do? I can’t pretend they didn’t happen. I can’t pretend they didn’t change the way I think about home birth. I can’t lie and say everything I know about home birth is peaches and roses and bliss, because now it’s not. I know better, so I have to do better — but what is doing better?

My feelings about home birth haven’t changed: for low-risk, healthy moms and healthy babies, home birth with a midwife is safe.

This doesn’t mean it isn’t without risk, and in some cases, even with low-risk, healthy moms and healthy babies, a home birth will have a higher (sometimes much higher) risk than a hospital birth.

In my opinion, a good midwife should discuss the risks with you. It’s not a midwife’s job (or anyone else’s) to talk you into doing a home birth with visions of blissful labor surrounded by candles and the wafting scent of essential oils. It’s their job to help you make informed decisions about your pregnancy and birth, and do everything they know how to keep you and your baby safe. And if a midwife is out of the realm of what she knows or what she can safely do, it is her responsibility to tell you, and then transfer your care to someone whose knowledge and expertise extends beyond hers.

I wish I had a magic formula to guarantee that every mother who wanted to do a home birth would get a good midwife. These questions from a Mothering.com forum are a good place to start. I recommend thinking about the types of answers you’d expect or want to receive before you ask them (even write them down!). Then compare your answers to the ones your actually receive from the midwife. The best fit will be someone who has the same philosophy about birth, life, and death as you do. You’re looking for someone who you can literally trust with your life and the life of your most precious loved ones.

The vast majority of midwives are fantastic. They are in the business because they love women and babies. They love being facilitators to empowering natural birth, and they’re humbled by their role of attending them. I feel incredibly blessed to know so many amazing midwives, and I’m so thankful they are able to do the work they are called to do.

So even knowing about the deaths of newborns after midwife-attended home births, I am still a home birth advocate, and still a midwife advocate. Home birth is physiologically normal birth. It’s ideal birth. It’s the type of birth the human race needs to preserve.

That being said — it’s not for everyone. No one should get talked into it — just as no one should be talked into hospital birth. Where to birth isn’t a decision that should be made out of fear, but it should be an informed decision. As an advocate, I have to share the good and the bad. What I know has change, but what I believe hasn’t, and I hope sharing what I know helps others make the right decision for themselves.

Photo credit: Llima on Flickr

*4/9/12 I modified this sentence from the original because I didn’t want conclusions to be drawn from the number of deaths and the timeframe. Although I only heard about these incidents recently, there are years and miles between them.

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{ 35 comments… read them below or add one }

1 Melanie April 2, 2012

All death is heartbreaking. No matter what happens, or where you are, if you lose your child during birth you will always question your decisions. No birth is without risk and I think your recommendations are very well stated. Educating yourself is the most important part of any birth, in my opinion. You can’t just step back and let someone else make all of the decisions and hope for the best. If you don’t know what to expect everything will catch you off guard. No one knows your body like you do, and knowing when to listen to yourself, and how to make others listen to you, is very important.

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2 Suchada @ Mama Eve April 2, 2012

What’s really tough is that something like this could happen to the most well-informed woman, and I want to be careful that we don’t move into territory of blaming mothers for midwife negligence. I think informing ourselves is a good first step towards having a positive birth experience and positive outcomes, but there’s always an “it” factor. I’m still learning about midwifery legislation which is very controversial, and I don’t know enough about it to form an opinion yet. In general I feel that licensing and regulation is a good step towards making midwifery and home birth accessible and safer, but the type of legislation and how it’s written needs to account for the realities of malpractice insurance and other hurdles. I hope that at some point in the future home birth midwives, doctors, hospitals, and emergency personnel will all be able to work together as a seamless team, which I think will lead to the safest births and best experiences for mothers and babies.

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3 The Joy of This April 2, 2012

Great post. Thank you for writing. Your feelings and thoughts echo many of my own. Actually, Navelgazing Midwife just wrote a great piece in response to Mothering’s article on questions to ask a midwife. She takes it a step further from what questions do we ask to what answers should we be looking for. Really informative. Here’s the link: http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2012/4/1/questions-to-ask-about-homebirth.html

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4 Suchada @ Mama Eve April 2, 2012

Fantastic resource! Thank you so much for sharing it.

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5 anna April 2, 2012

Great post! I really appreciate it, it’s very hard to find anything negative on homebirth advocates websites. I’m too lost a baby in homebirth, due to a negligence of a midwife. good thing I insisted on a transfer to the hospital, had an emergency c-section and a blood transfusion, had to stay in ICU for more than 24 hours, was really critical, but thankfully I made it. I just want everyone to know that the risk to loose a baby at homebirth is much higher than in the hospital. Unfortunately, I’m not the only one, I do know 2 women in the area that lost babies…. I don’t really like any religion, and I see a homebirth as new religion now,,, yes, it’s very natural, but women should know the risks and accept all the responsibilities of their birth, not blindly follow the religion… Think for yourself, always!

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6 Suchada @ Mama Eve April 2, 2012

Anna, I’m so sorry for your loss. What a harrowing experience — my heart goes out to you.

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7 Laura@Authentic Parenting April 3, 2012

Thank you for sharing this post. It is important that people know that there are indeed risks associated with birth… but also that one can be prepared for these.
I had planned a MW attended HB with this second baby, but felt confident and informed enough to do unassisted, I was keeping the midwives to call them in case of an emergency. I knew how to handle most complications that could arise during the birth.
However, 3 weeks before my due date, one of the MW’s started freaking and pushing me to do more testing then I was comfortable with and then told me that if there was shoulder dystocia we would both DIEEEE! Since this really didn’t inspire trust and made me wonder about her aptitude at being a midwife, I blew them off and had a full on UC.
My baby was born limp and we ended up in the NICU after the birth… but that was something we couldn’t have foreseen. I’m not sure if we had midwives things would have been different. Maybe we would have been able to stay at home, probably we wouldn’t, certainly not with that midwife…

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8 Suchada @ Mama Eve April 3, 2012

Wow, what an amazing story! I’ve always been in awe of UC moms because of the way they get so in tune with their bodies and prepare for it. Do you think you’d do it over again?

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9 Anna April 3, 2012

In my case, we would be better off with UC !!! And that would also saved us $4K, that the midwife did not even bother to pay us back… Also, talking about money, make sure your midwife has a malpractice insurance, I can’t even imagine, if our baby would survive, but would need a lot of medical insurance. I did not think about that before, but now I realize how important insurance is, and we certainly would not have means to take care of that very sick baby… It is just a reality, my ex-midwife did not have an insurance, and I did not bother to ask her in advance…

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10 Suchada @ Mama Eve April 3, 2012

That’s a really interesting point about the malpractice insurance. Where I am in California, very few midwives carry malpractice insurance because it is prohibitively expensive and they wouldn’t be able to have a practice if they did. In my experience, they are very upfront about this and you go into it with the understanding that if something happens, you won’t receive a large settlement from it.

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11 Sharon K. April 5, 2012

Definitely best for everyone to make an informed decision regarding their own births. My first child was born in a hospital. I used my OB/GYN I had been using since I was about 17. I had a wonderful, intervention-free birth but I felt like I had to hide in the bathroom for a lot of my labor, and they annoyed me b/c they instructed me to push before I felt an urge, so my muscles were all very sore for a few days afterwards. When I became pregnant the 2nd time, I chose a homebirth midwife- a CNM (she does not carry malpractice insurance, too costly. Her clients sign a paper acknowledging) So my 2nd, 3rd and 4th child were all born at home. Of course I was healthy and low-risk during my pregnancies, and I had wonderful labors and easy births. I keep in mind that there are several hundred babies born at home with excellent outcomes for every birth there is that does not have a good outcome. There are fetal and maternal deaths that occur in hospitals daily that we don’t hear about. Sure, there are of course some rare complications that could possibly resolved more quickly, or a better outcome overall had the mother/baby been in a hospital setting. When choosing a homebirth I was ok with that. My midwife has had her own homebirth practice for about 15 years. She has never lost a mother, and only 2 babies died in all those years- both had congenital defects and were not “compatible with life” (the parents chose not to do prenatal testing) I think those numbers are pretty amazing.

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12 Lauren @ Hobo Mama April 6, 2012

What a hard topic. Thank you for bringing it up, and I’m sorry you and your friends have been touched by so much loss.

It’s such a balance as a birth advocate (for any type of birth), to encourage and reassure women that they can birth successfully and (usually) on their own terms, and yet needing to acknowledge that, yes, birth carries risk. Extreme risk. And not all risks can be foreseen and managed, and you might make a heart-wrenching choice that you have to live with. It’s hard.

I had an unexpectedly unassisted birth with my second (the homebirth part was expected, but not the unassisted bit), and it went beautifully. And yet I still do worry sometimes as I hear stories like these about how wrong it could all have gone.

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13 NavelgazingMidwife April 7, 2012

I applaud you for speaking out. Sometimes it’s lonely over here being one to say everything is NOT perfect in birth. Everything isn’t awful, either, but for much of the Natural Birth Community, you best say all is well or you are seen as evil and just playing the Dead Baby Card. It isn’t so. Those of us who speak out, as you are doing here, merely want birth to be safer and women and babies to have all the safety they deserve. The “experience” is secondary; safety, primary.

And none of this speaks about how hospital birth must shift, too, away from assembly line “care” to individualized -care- where women are seen as humans and respected for their minds and choices. This requirement seems daunting, but one I will not give up on.

Thanks again and I am so, so sorry for the deaths of those precious babies. Now, I pray the midwives get their comeuppance, too.

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14 Suchada @ Mama Eve April 8, 2012

Thank you . . . it shocks me a little to think the midwife community wouldn’t speak out about deaths they know are due to negligence, or even the ones they know are not. I heard about these deaths because I’m involved with the midwifing and home birth community, and I feel fortunate that the people I know are extremely concerned about home birth safety and working towards making practices safer.

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15 Amy April 9, 2012

“The “experience” is secondary; safety, primary.” YES

Thank you for the response article on Questions to Ask about Homebirth. I also appreciate your work to bridge the care received in hospitals so that environment is more conducive to birth overall. As a momma who will birth where ever I choose (thus far twice in hospital and twice at home), I want the hospital to be friendly, too. :)

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16 Stillbirth Mama April 7, 2012

My baby died. It was a planned home birth. there was transfer. I am a medical mystery. I had 2 midwives and a doula. Even the Specialists at the hospital did not understand what happened.

I attend group therapy for parents of stillbirth and neonatal loss. In that room I am the ONLY home-birther. Everyone else’s babies died under the care of hospital midwives or obgyns. Some died before birth. Some died after birth. some died of negligence, some died of congenital defects, some died mysteriously.

Mothers and Fathers always wonder what if. We all ask What If I went to hospital… what if I had a planned c-section… what if I had a natural birth… what if I had an instrumental delivery… what if I had an emergency c-section… what if I had been induced early.. what if I had let baby decide on their birth day… what if, what if, what if…

You will never be happy with the choices.. hospital or home.. if your baby dies. You will always blame yourself for making THAT choice. No matter what you choose, it will be the wrong choice. Even if it was the right one at the time.

It never helps the heart to continually read of the blame placed upon families for choosing home birth, if there are adverse outcomes… Hospital didn’t prevent the other families from living through the death of their children…

I did not choose Home Birth for the experience, no matter how often people try to spin it so. I chose it because it was my best chance for a vaginal delivery. I had top level midwifery care. I do not buy into the Home Birth is the Only Way. But I am still tarnished with the same brush that the Birth fanatics paint us with. I do not believe that every baby must be born at home. I do not believe every baby needs to be born via vaginal birth. But people will always think of me as the woman who chose her experience over her baby’s well being.

It is a painful journey to walk… the one without your child in your arms.

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17 Suchada @ Mama Eve April 8, 2012

I’m so sorry for your loss. I hope you didn’t think I was blaming the families in this post. I realize that’s an attitude that many homebirth parents who have lost babies have faced, and I don’t condone it. In most places in the United States, the burden of finding a well-qualified midwife falls on families, and if something goes wrong they are told they were selfish for wanting that experience. It breaks my heart, and I wonder if it will change, even if well-thought-out legislation is put in place.

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18 Stillbirth Mama April 8, 2012

Oh No! I do not think you were blaming the families at all. But the mainstream opponents of Home birth will often voice the “Should have been in hospital” thoughts.

Even if legislation changes. Even if there is a system like the UK where hospitals support home birth with midwives. There will ALWAYS be opponents who will think – and sometimes voice – their thoughts that it was the mother’s selfish choice, that it was her fault something goes wrong.

The thing is, people forget that babies die in hospitals too. People forget that tragedy occurs with Doctors and Obstetricians and CNM and resuscitation machines right there. And if they do hear about those situations it will always be “they did everything they could”. There will always be a bias.

And having a cluster of home birth deaths in one community in a short period of time is horrendous. But it happens in hospitals too. I am familiar with a hospital who had not had a still birth or neonatal death in 3 years. It was a country hospital where high risk pregnancies were referred to major hospitals. This small hospital had 3 deaths in one week – 2 in one day. 2 were unexplained still births, 1 was Sudden Infant Death – died in mama’s arms suddenly while under the watchful eye of the midwife as she was learning to feed.

Just because clusters happen, does not mean that there is anything sinister about the situation.

My baby was one of 4 baby boys who died one after the other from the same online community. All were full term. All died in labour. All were born in a 3 week period. Our only connection was the internet – not location – and yet, we all faced this horror at the same time.

I am now in the horrible place of being a home birth that had an adverse outcome, a hospital born (c-section) baby from home birth transfer, someone who is stuck in a limbo between being a home birther and a hospital birther.

I cannot promote home birth as a safe option – when I am the poster child for “Things Go Wrong”

I cannot even face home birth women half of the time because I feel like I have the scarlet letter on my chest.

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19 Suchada @ Mama Eve April 9, 2012

Yes, I think these attitudes of blaming mothers persist for a few different reasons, and none of them are good. I admire your strength and your bravery for speaking out, and I hope you find a community where you are welcomed and understood. I think it might sound strange to some people, but one of the reasons I was drawn to the natural birth and home birth community is because I feel like it is a place where death and loss aren’t looked upon as shameful. I was at lunch with a group of four other women who all experienced loss in some way, and we could talk about it openly and freely. We mourned together but were stronger together as well.

You’ve inspired me with your journey – and I will hold you in my community. Thank you.

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20 Amy April 9, 2012

Thank you for sharing your story. It illustrates the experience that we are not in full control, we can’t control death. We try and the way you talk about the choices and blame, from the inside and the outside is so raw, so honest. I just commend you for continuing to walk the journey. Your strength is inspiring.

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21 Lia Joy April 8, 2012

That was really well said. Thank you for being a constructive part of this very important conversation <3

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22 NavelgazingMidwife April 9, 2012

UC = Unassisted Childbirth, though most say “Unassisted Birth” (for some reason UB never took off).

UC is when mom has her baby at home with no medical or midwifery attendant… or anyone with formal training in healthcare, midwifery care or midwifery care.

UP = Unassisted Pregnancy… when a mom chooses to have no formal prenatal or postpartum care.

There is a spectrum of choices a UPing/UCing mom might choose, from no monitoring the mom or baby at all (“Trusting” that all will be fine if left alone) to monitoring either with the help of friends or by their own hands. Many UCers will take a CPR class (inadequate since it does not cover neonatal resuscitation), read midwifery texts and participate in online and in-person discussion groups about how to keep the pregnancy and birth safe and to know when it is appropriate to transfer/transport to the hospital.

I had a hospital birth first and then my second was a UC. She was a shoulder dystocia that almost ended her life. My third was a car birth (homebirth turned hospital birth after extended rupture of membranes) after a solo labor.

Over the years, I’ve witnesses about 900 births and have heard thousands of stories. In my experience, I personally know two women whose babies died in their UCs. Who knows how many other babies have been damaged from the UC; we may never know.

I have never known a baby to die from negligence in the hospital. Negligence in this context means the staff didn’t do enough… didn’t do neonatal resuscitation correctly, didn’t have the correct medications, didn’t intubate or didn’t immediately have a team of personnel to attend to the babies life.

That people say, “Babies die in the hospital, too” makes me crazy because 99% of babies are born in the hospital, so, of course babies are going to die there. That so many homebirth babies are dying in a 1% (or less) population speaks volumes about the state of midwifery education and skills training as well as an standardization similar to midwives in Canada, Europe and Australia.

I have strong feelings about all of these topics (obviously), speaking out against UP/UCs as well as believing midwifery education and skills training should be elevated… considerably.

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23 Suchada @ Mama Eve April 9, 2012

I have had the great fortune of having highly-educated midwives attend my births (the first in a birth center, and the second at home), and I think because of those circumstances I didn’t realize how many skills could be lacking in other midwives. It is difficult to find the voice that will say both, “home birth is important for women and babies” as well as “home birth midwives need to have the highest standards of education and qualifications”. There is so much to learn about it, but so few people who really know all the ins and outs. It is a challenging situation, to be sure, and I’m not always sure of the best way to proceed. Thank you for sharing my article — I appreciate the discussion it’s generated here and elsewhere.

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24 MrsWJAA April 9, 2012

UC is short for Unassisted (or Unattended) Childbirth. It basically means that there is no midwife or ob/gyn, etc. at the birth.

Some women UC alone, some with close family, some with family and/or friends, and some even hire a doula.

UC’s are typically homebirths, but some women decide to have them in other locations as well.

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25 Cathy, aust midwife April 9, 2012

Could you please explain what UC is?

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26 NavelgazingMidwife April 9, 2012

See above. (I put it in the wrong REPLY, sorry!)

Also “baby’s” not babies. You’ll know where I goofed.

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27 Amy April 9, 2012

It may be helpful to have a disclaimer on all birth related articles that says something like “birth sometimes ends in death, please make choices you can live with” (thinking to self as I have written about my personal birth experiences at both hospital and home). Even that probably sounds harsh and blaming, in a world where people are blamed for death when it was completely outside of their control. In a world where blame is thrown for whatever goes wrong, in whatever setting…

Maybe an article about Removing Blame From Birth Gone Wrong is a post I’ll write one day. As a people, we could really benefit from letting go of blame and embracing a neutral, loving sense of responsibility and compassion.

Thank you, Suchada, for writing on this oh-so-pertinent topic. I have had close friends who lost babies, one recently in a home birth. The placenta abrupted and the baby died in minutes. No time to transfer. Her family was inquired as though they were criminals. Grieving was mixed with defense and anger, she felt she has almost no where to turn. Nothing felt right.

It opened my eyes to the way we approach advocacy as a whole. And death. Real stuff. Thanks again for discussing the topic.

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28 Amy April 9, 2012

Suchada, these two sentences caught my eye…

“Home birth is physiologically normal birth. It’s ideal birth.”

I think this *was* the case before we medicalized birth. In the present, it may not be the case for some and it is the adherence to those two ideas 9and some other convincing arguments) that some people may choose a situation that isn’t right for them, basing their choices on information outside of themselves.

In parenting, there always seems to be a better way – and in some aspects there are ways that result in less (or no) harm, more conducive and collaborative relationships, happier families, etc.

In terms of birth, though, it is possible that it’s not bad or wrong to be in the hospital; it is what works for the mother. If those of us who feel home birth can be a viable option “sell” it as ideal or normal and the other options being the opposite, we set up a divide among parents. We actually pit one against the other.

I am not saying *you* are doing this; I am just speaking to the tendency to make generalizations that do not apply to all and how it can affect people in their decision making process. Just writing this is bringing about a deepened awareness in me and I want to look through my writing to be sure I neutralize this tendency as best I. I just don’t want to feed a monster that is attacking parents at the base of their experience.

It would be simple to say there are no easy answers and we all judge, but what is our judgment doing to ourselves and each other? And is it accurate judgment? Who will hang on it thinking its absolute truth, then have an experience that proves otherwise?

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29 Suchada @ Mama Eve April 9, 2012

Amy, you’re right. I mean that home birth is physiologically and biologically ideal birth (in a comfortable place, free from interventions) — not in the sense that it is an ideal for all women. That clarification is so important, and I’m glad you brought it up.

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30 Jeff Wise April 9, 2012

Very thoughtful post and a lot of good follow up comments. Although I think home birth is more healthy and less stressful versus a hospital birth (we know midwives) there are things to think about which you mentioned in this post.

You’ve heard about a few baby deaths and that is horrible. All moms and dads should weigh their options and make an informed choice.

We’ve done natural in the hospital and that was even quite stressful. You are interrogated every 10 minutes about vaccines, tests, ointments and a dozen other things. If momma is healthy we will consider home birth in the future.

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31 Jen April 9, 2012

I too believe CPMs should have a longer, more in depth and more rigorous educational process, but I don’t believe they have to be CNM’s to be safe and competent care providers. There are plenty who would disagree with me, saying only CNM’s should be practicing. With the inconsistancies in CPM training, it is very tough to disagree.

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32 Suchada @ Mama Eve April 10, 2012

I couldn’t agree more! A CPM attended my second son’s birth, but her training is well above and beyond the requirements. I’m not sure how I would feel about someone with less training attending my births — it’s clearly something I need to read up on more to form an opinion.

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33 Liz April 19, 2012

I appreciate your post. I’ve read all sides of this argument, from the UCers on MDC to Dr. Amy’s blog. At one time I thought I would have a homebirth, but after my second child was born with very serious (and undetected) medical problems, I’ve had to give serious consideration to whether or not I think it’s safe. I am still undecided. I do know that some homebirthers will say “but babies die in the hospital, too!” and I think that is a very disingenuous argument. Apart from freak-type situations I would imagine that babies who die in a hospital due so because they had conditions incompatible with life outside the womb. I do wonder what would have happened to my daughter in a homebirth situation. She needed to be ventilated and I wonder what could have transpired in the precious time it would have taken to transfer to the hospital.

I have more questions than answers! :) But again, thank you for your thoughtful post.

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34 Stillbirth Mama April 19, 2012

Yes, it is hard to know. I question my own thoughts on whether homebirth is still as safe as I thought it was – and I have to think yes, generally. but there are a lot of things to take into consideration.

As for hospital and babies dying…. 1 in 135 babies die due to still birth. From 20 weeks onwards. In over 50% of these cases the causes are UNKNOWN. This means we cannot say whether or not they would have been compatible with life. We don’t know if the hospital made it safer or less so. We don’t know if home birth made it safer or less so. Because we don’t know enough.

Babies die suddenly in utero. it happens. This does not mean the baby was incompatible with life, it just means something happened. Some freak of nature that no one can explain. Some thing that is far beyond the argument of Hospital or Home.

(I know of babies who have died of hospital negligence, as well as babies dying of midwife negligence… again, it is not as simple as home vs hospital)

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35 Snickers April 22, 2012

I love to hear your thoughts. Please, join the conversation!

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