Homebirth Debate

Homebirth complications

There is poll on MDC about homebirth complications that has been updated on and off for the past 6 years. It is an unscientific poll, and, due to its wording, it may be that those women who had complications are more likely to respond than those who did not. Nonetheless, even the originator of the poll is suprised by the high rate of complications. One third of MDC repondents who had a homebirth had complications of some kind. Of those who had complications, approximately half sought professional medical help.

Although the creator of the poll is suprised by the results, I am not. It simply reflects the fact that having a homebirth does not change the inherent rate of complications. Homebirth does not lower the rate of complications, it just makes them more difficult to treat promptly and successfully. In other words, "trusting" your body accomplishes no more than any other form of pretending, which is to say, it accomplishes nothing.

The comments are quite revealing:

We had major problems with our planned homebirth -- lots of meconium in my waters throughout the entire labor, blood pressure getting into dangerous numbers, failure to progress at about 6 cms dilated, umbilical cord wrapped around dd's neck three times, her head turned in the wrong direction. We transported after about 12 hours of very difficult labor. Once we arrived at the hospital all hell broke loose -- apparently I had preeclampsia which had not been diagnosed by CPM, and I was headed for a seizure (liver and kidneys started to fail). Emergency c-section after 20 hours of labor. Still reeling from the grief of it all. However I must say that after being afraid of going to the hospital I actually had a decent experience there -- they didn't give us TOO much of a hard time for being "crazy home birthers," and they respected our wishes (no eye ointment, no vitamin K, rooming in, breastfeeding immediately, etc.). And the nurses were fabulous -- so helpful and attentive.

And:

My daughter was a planned homebirth attended by 2 certified nurse midwives. The pregnancy and delivery were perfectly normal until my water broke, which occured right at the pushing stage. There was a lot of meconium in the water and the midwives would have liked to transfer me to hospital, however my daughter was already crowning so there wasn't time. She was born breatjing (or trying to) but blue. The midwives had oxygen on her before her APGAR's were even done, and half an hour later she was admitted to the local hospital where the pediatritian had met us. Turned out she had severe meconium aspiration, her lungs were very full and she could not get enough oxygen into her bloodstream, even in an oaygen tent. The closest University hospital was called to come and transfer her after a few hours. She was placed on a respirator before the left, and by the time she arrived she was needing even more intervention. By the next day she was on a hert/lung bypass machine called ECMO and getting better. She spent 6 days on ECMO, 7 days on a respirator, and 3 weeks in the hospital...

Or:

... I had a midwife tell me s.d. is always "easy" to deal with at home, b/c mom can move easily, no epidural. Yet, after I lost my son to complications from s.d. the midwife admitted she had never seen "true s.d." True meaning 10 minutes has gone by, 10 positions have been tried and still no baby.

Sorry, I guess its obvious I`m one of the few whose hb didn`t work out. I hope I`m not scaring any pregnant mamas, I just have a hard time when s. dystocia is treated lightly.

Or:

I had thick, dark meconium when my water broke and it kept getting thicker and darker every time there was a gush of fluid. My MW said she could not attend me at home and recommended we transfer. We did. She had priveledges at the hospital we went to and still attended my dd's unmedicated, non-intervention (due to my fierce self-advocacy) vaginal birth. DD aspirated deeply (there's some scale they have that marks the severity and hers was as bad as could be; they showed me her x-ray). She did not take a breathe on her own after they worked on her for twenty minutes so she did have to be intubated and remained intubated for three days.

And:

DS had seizures for 2 days before we realized that anything was wrong. My mother mentioned that she thought she'd seen seizures when the midwife came back for a next day follow up, but the midwife said it was nothing to worry about, although she did call later on that day to recommend a visit with the pediatrician.

Well, after the visit with the pediatrician, who said that the child had never taken a full breath, I'm riding in an ambulance with a baby breathing only through a ventilator tube and we're in the NICU (neonatal intensive care unit - my vocabulary has definitely grown from this experience) for 13 days. He had a spinal tap, MRI, barbituates, and all kinds of things I never anticipated. I hadn't even wanted him to have the antibiotics in his eyes at birth.

DS suffered neurological damage (we're all - pediatrician, neurologists, and ourselves - hopeful that it's only physical) due to ischemia - lack of oxygen to the brain.

One commentor summed it up best:

I do want to say that we should not downplay the possibility of true emergencies in childbirth, especially for those who have lost babies to them. My good friend just lost her baby and uterus to a uterine rupture during an attempted home VBAC. Another friend has a permanently disabled baby from a shoulder dystocia. Another mother I know almost died and needed 18 units of blood after her uterus inverted. These happen and we don't do mothers any favors when we act like they don't. And furthermore, this thread reminds us all that there are definitely incompetent care providers out there. Rather than asking questions like "How much do you trust birth," I recommend actually finding out if your midwife has any experience handling an emergency at all. During the aforementioned shoulder dystocia, the midwife freaked out when she couldn't resolve it and left the room.

posted by Amy Tuteur, MD @ 9:31 AM