Wednesday, August 29, 2007

Coroner: homebirth midwives' inaction led to baby's death

This story from illustrates all too clearly why a baby can easily die at a homebirth. The midwives refused to call for assistance during a bradycardia, and (not surprisingly) when they attempted to intubate the lifeless infant, they put the tube in the wrong place. Almost certainly, they had no prior experience with a real infant intubation.

According to the coroner:
The coroner reports that the labour, attended by two midwives, seemed to progress normally until the mother's water was broken. The midwives noticed the presence of meconium in the amniotic fluid -- a life-threatening development.

Rather than calling for emergency help immediately, the midwives continued the birth.

When they later noticed that they had lost the baby's heart rate, they again failed to call for help, nor did they perform an episiotomy to hasten the delivery.

When the baby finally emerged, it was limp, grey and had no heart rate. Only then did the midwives call an ambulance -- a full 12 minutes after they noticed the lack of heartbeat.

While waiting the 10 minutes for help to arrive, they attempted to intubate the baby to suction out the meconium from the baby's lungs. When paramedics arrived, they found that the intubation had been done improperly and the child was declared dead shortly after.

[The coroner] determined in his investigation that the baby likely died less than 15 minutes before its birth. He contends the midwives were competent and knew what was happening, but failed to see the need for help.

Under Quebec law the baby should have been transported to hospital. In fact, the [baby's] home was minutes from Montreal's Maisonneuve Rosemont hospital.
This was a classic set up for a homebirth death. The midwives' elected to do a high risk birth at home. They did not call for backup when they diagnosed fetal distress. It was irrelevant that they were close to the hospital. And, of course, they were incapable of performing a correct neonatal resucitation. This was yet another preventable neonatal death at homebirth.

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