Saturday, May 12, 2007

Death at homebirth: a real world example

For most women contemplating homebirth, the small increased risk of preventable neonatal death at home seems purely theoretical, and therefore, easily dismissed. Therefore, the example entailed on a personal blog is unexpected, powerful and difficult to forget. It has also become controversial. That's because the mother has posted repeatedly and in detail how she has convinced herself that she has no responsibility for the outcome. She has received copious support in this view from other homebirth advocates. Inevitably, though, since it is a public blog with public commenting, a few posters have questioned that view. The response has been pure, unadulterated vitriol.

My view on culpability is that there is no question that the parents bear significant responsibility for the death of the baby. The baby died because of unanticipated fetal distress. By the time the mother reached the hospital and had an emergency C-section, the baby could not be resucitated. The baby had slowly suffocated to death because the only appropriate medical care was not available at home. My view on the blog is more ambivalent. While the mother claims to be sure that she bears no responsibility for what happened, raising the issue for public debate suggests a degree of uncertainty. Although she and other homebirth advocates express shock and horror that a few posters question the wisdom of her decisions, she could not fail to anticipate that this would happen and she highlights these dissenting views on the main page.

Regardless of the propriety of the various comments, the blog itself represents an object lesson in the increased risk of preventable neonatal mortality at homebirth. As such, it should be required reading for anyone contemplating homebirth and anyone encouraging others to contemplate homebirth.

NB: Obviously you should feel free to leave supportive comments on the personal blog. However, I would ask that if you have any comments that the mother would find hurtful, or you just want to contribute to an academic discussion on this case, that you would leave those comments here. If the mother wants to read them, she can follow the link back from her blog. If she is not interested, she does not have to see them.

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