Sunday, September 23, 2007

Unbelievable. Yet another homebirth death

I know that homebirth is not safe for babies, but even I am shocked at the number of homebirth deaths in the news recently. Here is yet another completely preventable homebirth death reported in the Register-Guardian in Oregon:
There is no disagreement that the death of Kelsie Koberstein's baby during a complicated delivery was a heartbreaking tragedy. But a chasm has opened between the people who support Koberstein's decision to have her baby at home despite known complications and those who believe her midwife was unforgivably irresponsible - maybe even criminally negligent - to proceed with the home delivery.

With passions high on both sides of the issue, it's essential to acknowledge that the loss of Lucian Koberstein has deeply pained everyone who fought so desperately to save him, none more than his mother.

But also affected were midwife Anita Rojas, the paramedics who frantically tried to assist the birth after they were summoned to Koberstein's home, and Sacred Heart Medical Center emergency room obstetrician-gynecologists Drs. Elizabeth McCorkle and Brant Cooper, who brought every ounce of their expertise to the frenzied and ultimately unsuccessful effort to prevent Koberstein's difficult breech delivery from going totally wrong.

McCorkle and Cooper are certain they could have saved Lucian had Koberstein either begun her labor in the hospital or made it there much sooner after complications emerged. They hold Rojas responsible for proceeding with a high-risk delivery, and Cooper filed a complaint against her with the state Board of Direct Entry Midwifery, which oversees licensed midwives..."
According to the original article on the tragedy:
The call to paramedics came at 8:10 p.m., the instant midwife Anita Rojas realized the head of the breech baby she was delivering was stuck.

Twenty-one-year-old Kelsie Koberstein was swept up by medics in a blur of pain and fear.

Rojas rode in the front of the ambulance, with Koberstein's mother and best friend rushing behind in their car...

On her back, her legs pushed up as high as they could go, she clutched the hand of a paramedic as if he were her only anchor to reality.

Those minutes, so frantic for so many, ticked by slowly for her. As paramedics tried to wrest the baby out, Koberstein said she could sense the small life, still partially within her, beginning to fade. She began "letting him go, in a way."

At Sacred Heart Medical Center, the on-call emergency room obstetrician-gynecologists, Drs. Elizabeth McCorkle and Brant Cooper, wasted no time.

As they instructed paramedics over the hospital radio, they learned this birth was going to be as difficult as they come: It wasn't just a breech birth, but a "footling" - where a foot emerges first.

Just a few centimeters in width, a tiny foot might not open the cervix wide enough to allow the baby's head and umbilical cord to pass through. If the head becomes trapped, the baby could quickly suffocate.

When medics pulled up to the doors, the doctors leapt into the back, refusing to squander precious seconds bringing Koberstein inside. The doctors had to turn Lucian's head 180 degrees in order to free him, a move that took at least 20 minutes.

By then it was too late.

The infant was dead.
The diagnosis of breech was made at 37 weeks and attempted version failed. The article describes the delivery:
Everyone was calm as the delivery progressed.

But then Koberstein reached down and touched what felt like a tiny heel emerging. It popped out. Stunned, she asked Rojas if everything would be OK.

In about a half-hour, Lucian's entire body was out. But his head remained stuck.

She left the decision of when and if to call an ambulance up to Rojas, who, as a licensed midwife for 13 years, had the experience, Koberstein said.

Rojas encouraged her to keep pushing, and had her climb out of the tub to try another position. Koberstein continued her labor.

Koberstein's mother grew more nervous, hanging back.

They wrapped Lucian's body in a towel, and tried to deliver him as she stood, then again as she lay down.

Rojas asked Koberstein to keep pushing, but she could not feel anything behind her thrusts.

It was then she heard what seemed like a hint of panic sneak into her midwife's voice.

"Anita said, 'Call the ambulance,' " to an assistant midwife, Koberstein said.

She felt totally helpless.

Finally, the ambulance arrived.

At the hospital, the awaiting doctors worked frantically to save Lucian. At one point, at least seven people - doctors, nurses, paramedics - were crammed into the ambulance, working in full sight of passers-by on East 13th Avenue.

"It was horrible," Cooper said. "You've got a baby that's all but delivered. You've got 15 people standing there watching these two doctors sweating, trying to deliver this baby."

"You're watching a baby die in front of your eyes."

... In his complaint to the midwifery board, Cooper outlined a number of points throughout the birth where Rojas could have saved Lucian.

In speaking with Koberstein after the failed delivery, he believed that she was uninformed about the risks involved with every step of the birth - including how hazardous a footling breech is.
We have a midwife so afflicted with hubris or ignorance or both that she thought she could safely deliver a footling breech at home, a patient who almost certainly was not counseled about the REAL risks of her situation, a horrific delivery, a dead baby, and a completely preventable tragedy. This is what homebirth looks like.


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