MDC homebirths 2008: death #14
She fired her OB because he wanted to induce her for postdates. The baby died.
My OB is insistent on an induction before I get to 42 weeks ... But when I asked today why we had to schedule an induction for monday, i was told that it would be malpractice for them not to. I then pointed out all our family babies are late, I was #4 and 3 weeks late, and told that that was the 70's and it's just not done that way anymore. I then asked what was the medical necessity for inducing me, and told that it would be medical malpractice to allow a pregnancy to go past 42 weeks. it was like talking to a wall. So I let them schedule me for Monday am- 4:45am- bleah.
what if I don't show up? can they fire me? can they just be mad at me, but still manage the pregnancy by monitoring a little longer? will I go to jail for not showing up?
I have good feelings that this pregnancy is fine, but that she's (and my body) not ready for birth yet...
Her compatriots on MDC encouraged her to risk her baby's life. Consider this from UC advocate Rixa Freeze of "The True Face of Birth":
... I would be very hesitant to agree to an induction... No need to interfere because of an arbitrary deadline, especially if that deadline may or may not be very accurate.
You were WRONG, Rixa. Do you plan on taking any responsibility for your role in this tragedy?
Early this morning, posted by another MDC member:
After a long labor, her daughter was finally born this morning (11/20) but it is not the happy ending we all were expecting.
Her daughter was born with a head full of black, curly hair, 8 pounds, 5 ounces, and she was born sleeping.
... She had a very long back labor and labored as long as she could at home with the midwives. I believe she transferred somewhere around dinner time last night to the hospital for pain relief. She and the baby were doing fine and the heart tones were good upon transfer. It's my understanding that once she arrived at the hospital ht's weren't detected and an US confirmed the baby had passed. She was started on Pit and the baby was born this morning. Txgirl said to let you all know the baby had the cord wrapped twice around her neck and the cord also appeared to be short. She went ahead and consented for an autopsy which may or may not provide more detail of what happened.
The baby was not born sleeping. Only live babies can sleep. The baby was born DEAD. Had the mother consented to the induction, the baby would almost certainly be alive today.
Labels: homebirth death
No, Arwyn, homebirth is not statistically the safest
The folks at MDC appear to be concerned. Someone has posted a respectful, non-inflammatory post about the many homebirth deaths among her friends. The moderator, Arwyn ("Birth Goddess") has interrupted to state the position of MDC. I'm not sure whether MDC is primarily concerned with blunting the impact of the original post, or responding to the role that MDC has in promoting practices that apparently lead to neonatal death fairly routinely.
Birth is safe, but it is not, and never can be, risk free. Every woman should birth wherever they feel safest, but we (Mothering magazine and MDC) support and promote natural birth as the default option because, statistically, it is safest. It is the "best" option overall. It is not best for every motherbaby, for every birth, for every situation, but the truth is that our maternal and neonatal mortality and morbidity rates would be lower if the majority of births were intervention-free rather than highly medicalized. Thank G-d/dess we live in a time and place where we have access to medical technology, to medications, to surgical birth, because sometimes they are needed. But they are, on the whole, overused.
Here's a newflash, Mothering magazine and MDC,
homebirth is not , statistically, the safest. In fact, homebirth with a direct entry midwife is the most dangerous form of planned homebirth in the US. Let me refresh your memory in case you have not seen the data from the most recent US dataset (Linked Birth Infant Deaths 2003-2004).
As this chart shows, the neonatal mortality rate for DEM assisted homebirth is almost double the neonatal mortality rate for hospital birth with an MD. This is all the more remarkable when you consider that the hospital group contains women of all risk levels, with all possible pregnancy complications, and all pre-existing medical conditions. An even better comparison would be with the neonatal mortality rates for CNM assisted hospital birth. The risk profile of CNM hospital patients is slightly higher than that of DEM patients, but CNMs do not care for high risk patients. Compared to CNM assisted hospital birth, DEM assisted homebirth has TRIPLE the neonatal mortality rate.
Neonatal mortality would not be lower if births were "intervention-free," it would be much higher.
If 10% of American babies were delivered by homebirth, homebirth deaths would vault to the 3rd or 4th leading cause of neonatal death!Arwyn, if you want confirmation of the national data, just check your own website. There have been at least 13 preventable neonatal deaths and 2 cases of severe anoxic brain damage among MDC members in the past 10 months! Homebirth increases the risk of neonatal death. How much data, and much tragedy aided and abetted by your own site, do you people at Mothering and MDC need to see before they acknowledge the truth?
Labels: homebirth death
Shoulder dystocia and 13th MDC homebirth baby dies so far this year
Another senseless death at homebirth. From the father's blog:
We had a terrible tragedy yesterday. L. had a long, hard labor. The child would move a bit and then stay, then move a bit more and then stay even longer...
But the shoulders were stuck. The midwives went into emergency mode and essentially pulled the child out of L., but by then it was nearly too late. He was blue when he emerged and the cord was only pulsing weekly.
All hell broke loose. 911, paramedics, the hospital, L. on the ground sobbing, it was horrible. And it is seared into my mind forever. I was the only one with him at the hospital while they worked on him at the trauma ward. They got his heart beating and he started breathing, but it had been a long time...
He was beautiful. Perfect and tiny, everything intact and finally there was a heart beating...
The doctors told me that they had done a a variety of tests on him to see how well his brain was functioning, and the news was not good. Terrible, in fact. He was brain dead, they told me and that once off the ventilator he would would pass on very soon later.
They brought me to him in the NICU and I sat and held him in my arms for a while, just us... I know that I will always cherish those hours with him despite the cords and beeps and horror of hospital. His heart was beating, he was pink and alive, and he was in my arms...
... At 3am this morning they brought him to us, once he had passed. His name was S. and he will be a part of us forever.
This is the 13th preventable homebirth death on MDC so far this year. In addition, there have been at least 2 cases of profound anoxic brain damage. That is an increase in deaths from 2007, when there were 10 preventable homebirth deaths reported. Considering that there are less than 30 homebirths per month on MDC, 13 deaths means a neonatal death rate of more than 40/1000. Compare that to the death at low risk hospital birth of less than 0.4/1000. That means that the MDC homebirth death rate in the past 10 months has been an extraordinary 100 times higher than the hospital death rate.
post edited at 9:36 PM per father's requestLabels: homebirth death
No, you did not do everything you could to keep him safe
Yet another needless, senseless tragedy in the parade of needless, senseless tragedies that is unassisted childbirth.
Posted on the MDC UC board on 10/13/08:
Anyhow, thought I'd share the interesting events of today and see what you ladies think. I personally don't know WHAT to think.
So, we plan to uc again after our last success. I chose to seek traditional prenatal care due to having chronic hypertension for which I need low dose meds. I never told doc that, he only knows that I have homebirthed in the past. Everything has been pretty low key for the most part considering my " high risk" status - according to their standards. Until 37 weeks that is. At that point an air of unease started to set in for no reason with the ob, his mw and staff. It was as though they became determined to find a problem even mentioning pulling the plug so to speak on a few occasions... Indicating there would come a reason to induce. I was asked to come in for repeated u/s and then they wanted me to have a level 2 on one day as well as a hospital nst and then come directly to the office for yet another nst so they could compare info... You can imagine I was slightly stressed before I left when he asked me what I would do for child care had he needed to induce me that day. Uh, walked out?
... I decided the best thing to do for my peace was to not go back for now. I have all the tools I need at home to manage myself and would never hesitate to get help should I need it. Well they literally called every day since and today-2 weeks later a visiting nurse showed up on my door step!
It ended up a very good experience but I'm still very wierded out and not sure what to think…
She received 11 responses expressing outrage and declaring that the doctor was out of line, including this one on 10/17, ending:
I am sure everything is fine, and that we will be reading an awesome story about you and your babe very soon.
Posted on the MDC UC board this morning:
Our baby ... was born still on oct 19th at 5:48 am. He was 7 lbs 10 oz. 19 1/2 in and as beautiful as an angel. We had him at the hospital as I didn't feel him and couldn't find his heartbeat that day. The cause is a mystery ... He was perfect. I am completely devistated and in shock. I just can't understand how or why after all that I did to keep myself and him safe... How could he just stop for no reason? My precious baby is gone.
Labels: homebirth death
CPM who presided over 2 deaths in 6 weeks reaches plea agreement
Kristina Zittle, the CPM who presided over 2 homebirth deaths in the span of 6 weeks (
CPM presides over 2 separate deaths in 6 weeks) has agreed to surrender her license and not contest her suspension from the practice of direct entry midwifery. According to the
Virginia Pilot:
A Virginia Beach woman has agreed to give up her state license to be a midwife rather than go before the Board of Medicine on allegations she failed to adequately treat two pregnant women whose babies were born dead.
Michael Goodman, an attorney for Kristina Zittle, said in an e-mail that Zittle "vehemently disagreed" with many of the allegations in the Board of Medicine notice that led to the suspension of her license in September.
He said she was able to sign a consent order without admitting or denying any of the allegations, and decided that was the best course at this time.
"She did not feel that she was financially equipped to battle this although she felt that most of the statements were either untrue or jumped to unfair conclusions," Goodman wrote in an e-mail sent on Monday.
Zittle was scheduled to go before the Board of Medicine for a formal hearing on Friday. A consent order relinquishing that right was signed by the Board of Medicine executive director William Harp last Friday, which made it public record.
I'm not surprised that she voluntarily entered into the agreement. Her lawyer almost certainly told her that she was going to lose her license anyway, and that the information entered into the public record during the hearing process would simply provide better high quality transcripts for the malpractice attorneys who will prosecute future malpractice suits against her.
From the Board's point of view, this was a victory. The entire purpose of the hearing process would have been to show that she was such an incompetent practitioner that she should be deprived of her license permanently. It is of no consequence to the Board whether she admits her culpability or not.
With cases like these, it's not surprising that the Midwives Alliance of North America (MANA) refuses to release the detailed safety statistics that it has collected. Their own statistics almost certainly show that homebirth increases the risk of neonatal death.
Labels: homebirth death
What is wrong with these people?
Today on MDC a mother posted that she is so proud of herself and her baby for her HBA2C.
Too bad the baby was unexpectedly born dead.
What is wrong with these people? Her own baby is dead and her first thought is for her birth "performance". Perhaps it had not yet crossed her mind that if she had a scheduled C-section her baby would be alive. I cannot imagine any other reason for being "proud" of herself for a decision that killed her baby.
Her reaction is a powerful indictment of the homebirth movement and its grotesque cultural construct that literally places more importance on transit of the baby through the vagina than on the baby's life.
Is vaginal delivery so important that it's worth killing your baby in the process?
Addendum: Yet another homebirth death was just posted on MDC this evening. Fetal distress was noted at home. By the time they drove to the hospital, the baby was dead.
Labels: homebirth death
UC neonatal death 20 times higher than hospital rate
An MDC member has just updated the statistics for planned unassisted births among MDC members. The death rate for UC is appallingly high at 8/1000. Compare that to national statistics for low risk hospital births attended by a CNM with a death rate of 0.37/1000. That means that the UC death rate on MDC is 20 TIMES the death rate that would be anticipated for low risk women in a hospital.
UC is a form of medical neglect, and babies are paying the price. Indeed, yet another UC death was reported on MDC within the last few days. The baby was born and appeared to be well. The parents fell asleep and when they woke up, the baby was dead. The presumed diagnosis, pending an autopsy, is undiagnosed heart disease.
Labels: homebirth death
CPM presides over 2 separate deaths in 6 weeks
A Virginia CPM was suspended from practice last week concluding that she posed a "substantial danger to public health or safety. She presided over, and appears to be responsible for, not one, but two separate neonatal deaths in a 6 week period.
The midwife made so many egregious errors during the care of both mothers, that they can't possibly fit into one post. The
evidence presented at her suspension hearing is chilling. Regarding Patient A:
... Ms. Zittle did not perform a vaginal examination of Patient A until ... approximately six hours after contractions began and approximately 27 hours after the spontaneous rupture of membranes, at which time Ms. Zittle incorrectly identified the presence of a nuchal hand.
Although a vaginal examination at 5:02 a.m. ... revealed Patient A to be 8 centimeters dilated with the foot, thigh, and shin of the left foot presenting, Ms. Zittle ... did not transfer Patient A to the hospital. Even though Ms. Zittle had never before performed a breech delivery, she opted to continue with a home delivery ..
Delivery of Patient A's infant began at approximately 6:06 a.m., when the left foot delivered... Ms. Zittle ... did not physically intervene to assist the delivery of the infant until approximately 6:35 a.m., when the pulsating umbilicus emerged and Ms. Zittle used her right hand to prevent cord compression. The infant's buttocks emerged at 6:22 a.m. and by 6:38 a.m. the chest, only to the nipple line, had cleared the cervix. Although Ms. Zittle subsequently noted that the umbilical pulse was getting weaker and, at 6:40 a.m., documented the absence of a fetal heart rate, she did not initiate a 911 call until after the infant was born at 6:42 a.m. in a lifeless condition... Ms. Zittle immediately began performing Delee suction of the mouth, then nose, and began performing CPR, which she had never performed before on an infant.
An autopsy on Patient A's infant revealed that the liver had ruptured, spilling 55 cc's of blood into the abdomen, and also that the infant was positive for Group B strep infection. The Medical Examiner who performed the autopsy stated that the condition of the liver indicated that the infant had been breech for some time; that the rupture had developed over time, most likely from being pressed against Patient A's hard pelvic floor; and that "a c-section would have been life saving in this case."
Patient B, expecting her 3rd child:
Ms. Zittle failed to respond in a timely fashion to ... the intensification [of patient's contractions] around 10:O0 p.m. on June 9, 2008, in that she did not leave to go to Patient B's home to attend her labor and delivery until approximately 12:34 a.m. ... notwithstanding the 45-50 minute drive anticipated to Patient B's home and the fact that Patient B was located approximately 17 miles from the nearest hospital and lacked transportation at that time...
En route to Patient B's home, after Ms. Zittle was aware that Patient B was in the midst of a footling breech delivery, EMT personnel informed Ms. Zittle by telephone that Patient B's infant had been delivered up to the chest but they were unable to further deliver the infant. Notwithstanding this information, Ms. Zittle instructed EMT personnel not to take Patient B to the hospital, but instead to assist Patient B in delivering her infant at home in the birthing tub. Ms. Zittle also instructed EMT personnel to wait for her arrival, estimated to be approximately 30 minutes later, before transporting Patient B to the hospital.
After transport to the emergency room by EMS, at approximately 1:37 a.m. ..., Patient B delivered an infant with a distended abdomen and without respiration, color, movement, or a heartbeat, who was pronounced dead... The cause of death listed on the death certificate was umbilical cord entanglement and compression subsequent to breech delivery.
This midwife is still advertising her services on her own website, although she claims she is available only as a monitrice despite her status as a certified midwife.
Labels: homebirth death
Homebirth death in Australia
Unfortunately, I run across stories of homebirth deaths so routinely, I've stopped blogging about each one individually. I thought that this one was worth mentioning because of the knee jerk reaction of the doula. Although no cause of death has yet been determined, the doula claimed: ""I can assure you, this wasn't home birth-related."
You can find the complete story
here:
A newborn died after a woman ignored the pleas of doctors and nurses and gave birth at home without medical support.
The tragedy, which has been referred to the coroner, confirms the fears of maternity experts who are alarmed at the trend of women shunning the health system in favour of risky, unsupervised home births.
The baby died last Sunday three days after the mother presented at Nepean Hospital. Doctors found the baby was fine but warned the woman she was at high risk of complications, including the rupture of a scar from a previous caesarean. They said they wanted to induce labour immediately.
She refused and returned to her Blue Mountains home where she later gave birth to a stillborn baby.
Two doulas, who are not medically trained but provide emotional support for women before and during childbirth, and a qualified independent midwife were called but arrived too late.
The baby's father told The Sun-Herald the doulas had told him the baby was stillborn due to an infection contracted inside the womb.
He said: "Would the baby have lived had we been in hospital? I have no idea. The suspicion is that there was an infection prior to birth. I'm told it was a freakish occurrence that happens one in a thousand cases."
The man said his wife was "in a very bad way"...
One of the doulas present at the birth said: "I can assure you, this wasn't home birth-related. There was an infection a long time before."
So let me get this straight. The baby died from a long standing infection, but she's sure that has nothing to do with the homebirth? Does she think they wouldn't have noticed this at the hospital? Does she think they wouldn't have treated it? Does she think that they wouldn't have monitored the baby during labor and waited to find out it was dead when it was finally born, as she did?
If the baby died of infection, the likely cause is group B strep sepsis. In that case, it almost certainly was treatable, and very likely preventable.
How can homebirth providers learn anything when they won't take responsibility for their own disasters?
Labels: homebirth death
Heartbreaking story
I have been following a new blog since it was started several weeks ago. The blog is called
One More Day and it is beautifully and powerfully written. I have received permission from the mother who writes the blog to link to it and to quote some of her writing about the loss of her daughter after homebirth. I'm sure that everyone understands that if they have comments that are anything less than totally supportive, they should make the comments here and not on her blog.
From her first introductory post:
I am a mother to 5 wonderful children here on earth. My youngest child passed away after her birth... My children mean everything to me and losing one has been devastating... I was a totally crunchy mom but am now questioning all of that. I have had two homebirths. One turned out awesome and the other, turned out horrible. I feel that if I had just trusted the actual professionals, my baby would be here. Now, since I feel homebirth was wrong, I question my not vaxing philosophies. I am seriously thinking about catching my last three children up. I hate second guessing myself.
In her current post,
A note about homebirth she recalls:
... You know when people would tell me that babies used to die because they were born at home, I had my "research and statistics" to back me up and prove they were wrong. Wanna know one thing I have learned now??? We don't hear about deaths after homebirths because of the stigma. Your baby dies in the hospital and people feel sorry for you. Your baby dies after a homebirth and people automatically blame you, even if it wasn't your fault...
She writes about how women are lulled by being low risk:
We talk about how if your low risk home is much safer. I have NEVER been high risk before yet home was the worst place my daughter could of been after her birth. Please, please think about how you promote homebirth as being so safe and wonderful. My daughter is dead because of homebirth. You don't want to be a number or a statistic.
She offers words that should be read by anyone contemplating a homebirth or promoting the safety of homebirth:
My 4 hospital babies are here and healthy. Out of my two homebirth babies one is here and healthy while the other is in a cemetery. She is proof that homebirth isn't as safe as we all think.
Labels: homebirth death
8 homebirth deaths on MDC so far this year
Another homebirth death has been reported on MDC. That makes at least 8 homebirth deaths reported in the past 6 months. In addition, there have been at least 2 cases of profound anoxic brain damage that occurred at homebirth and resulted in babies with significant disabilities.
We know from
US government statistics that homebirth increases the rate of neonatal death to double or triple the death rate for hospital birth with an MD or nurse midwife. We also know that, for a variety of technical reasons, the US government statistics almost certainly undercount the rate of homebirth death. However, the steady, unvarying progression of one homebirth death after another on MDC illustrates the human toll more vividly than any table of statistics.
What is it going to take for homebirth advocates to realize that they have been mislead, misinformed and lied to? Homebirth increases the risk of neonatal death. There is no question about this. The only people who have not gotten the message (or prefer to ignore the message) are homebirth advocates themselves.
It is important that women contemplating homebirth understand that homebirth leads to the preventable deaaths of babies, far in excess of any preventable deaths in the hospital. It is also important that women contemplating homebirth understand that reading and talking to other homebirth advocates does NOT mean that you are educating yourself. Homebirth advocates, either because they do not understand, or because they are deliberately hiding information, will not tell women are the real risks.
Women in general, and homebirth advocates in particular, must insist that MANA (the MIdwives Alliance of North America) release the safety statistics that they have been hiding. MANA is sitting on what is probably the largest database of homebirth statistics in the world. It probably contains 30,000 homebirths or more. MANA has PUBLICALLY offered the statistics to those who can prove that they will use them for the "advancement of midwifery". Even then, recipients of the data must sign a legal non-disclosure agreement. The public is not allowed to see the 7 years of safety statistics. Presumably, giving women information on the safety of homebirth is not going to "advance" homebirth midwifery, so the data remains hidden.
I suspect that the folks at MANA have come to feel that they have no choice. The safety data is probably so appalling, the risk of neonatal death is probably so high, that MANA must keep this information suppressed. I have a public plea for MANA:
To the Director of Research at MANA,
Please release your safety statistics to the general public. Please put the needs of babies and mothers ahead of the needs of your organization. If you are in possession of data that shows homebirth to dramatically increase the risk of neonatal death, it is unethical for you to withhold it.
If you release the statistics now, you may be able to prevent some of these avoidable neonatal deaths. If you wait, we will find out anyway. The US government has begun collecting statistics on homebirth, and the first set already show that homebirth increases the rate of neonatal death. A research organization in the UK is currently conducting a large scale study of homebirth in the UK with the results to be announced within the next 1-2 years. We are going to find out the truth. Do what you can to reduce deaths at homebirth but sharing what you know now.Labels: homebirth death
Two more homebirth deaths reported on MDC
The steady pace of preventable deaths at homebirth continues on MDC. Two additional homebirth deaths were reported on MDC in the past week or so. Both were intrapartum deaths. One was 6 months ago, and the other occurred a few days ago and was the result of an abnormal cord insertion.
In both cases, mention was made of grief being compounded by blame from family members for risking the babies' lives.
At this rate, sadly, MDC should start a "tribe" for women whose babies have died a preventable death at homebirth. There have been 7 homebirth or UC deaths that have been described on MDC since January. There have also been at least 2 cases of profound anoxic brain damage. This is ahead of the steady pace of homebirth deaths reported on MDC, approximately 1 every other month, in the previous 2 years.
It's no wonder that MANA (the Midwives Alliance of North America) refuses to release their statistics on homebirth safety. If MDC is any indication, the perinatal mortality rates at homebirth are extraordinarily high.
Labels: homebirth death, neonatal mortality
The birth was "beautiful and empowering"; both unanticipated twins were dead
There was actually ANOTHER homebirth death in the
news yesterday. In this case, it was the stillbirth of unanticipated twins. Twins are a high risk pregnancy and they deserve additional careful monitoring. Identical twins can be at even higher risk than fraternal twins, because their placental circulations can become interconnected, hurting both babies. Identical twins can also be in the same sac. This is dangerous because their umbilical cords can become tangled in each other.
According to the article:
Laura and Rick have been married five years...
After learning they were pregnant, the two agreed to have a home birth with midwives. The decision to use midwives led to criticism following the deaths; however, the couple plans to do everything the same next time.
This includes no pain medication during delivery.
Laura said the birth was empowering and beautiful.
The stillbirth was diagnosed at 37 weeks.
"The week before we had a prenatal visit, and there wasn’t any indication that we had something wrong — and then the next week they couldn’t find the heartbeat," Laura said.
She said this visit was on a Thursday, and that it was estimated the deaths occurred either Tuesday or Wednesday.
"And I was very surprised that I didn’t know."
So much for the vaunted "intuition". She did not know that she was carrying twins, and she did not know that they had died.
The mother transferred to the hospital for induction. The delivery was uncomplicated. Both the mother and her family felt that she had received excellent care in the hospital, but the mother was unhappy with what happened next. As she writes on her own
website:
"Once people finally left the room, the doctor came back in. She had a conversation with us that implied that this was happening because my midwives were not competent, that I was foolhardy for the course of action I chose, and that I should absolutely think carefully the next time I decided to have a baby. (As if there was a complete lack of planning in the first case.) I can’t really imagine and appropriate time to have this discussion in this manner, but certainly right after birth and tragedy was a completely inappropriate time...
To make matters worse, the doctor came in the following morning to have the same conversation. When Rick told her we did not want to hear it again, she kept going. This time, the conversation included "not feeling listened to the night before" (because most people that have just given birth and lost two daughters are really good support systems for the doctors) and that she "does not like having to come to work to deliver dead babies." Needless to say, I was extremely angry at this point, and in the whole course of events, this was really the only thing that I felt that I should be legitimately angry about."
There is so much denial going on here, that the mother actually believes that the doctor's complaint that she was "not feeling listened to" was about the doctor's need for emotional support. The doctor didn't need emotional support; it was not her babies who died. The doctor was trying to get through to these parents that poor prenatal care by unqualified providers had contributed to or led to the deaths of their daughters. The parents heard the words, but refused to understand and acknowledge their meaning.
Labels: homebirth death
Another UC death on MDC
Yet another unanticipated stillbirth at UC on MDC. The baby was known to be breech. In addition, the baby had not been moving much, but mother declined the ultrasound that was recommended by her midwife:
... I did have a mw appt on Thursday morning... and she thought she felt head up as did I. I declined the doppler and she was unsuccessful finding the heartbeat her stethoscope. This was the 2nd time though so didn't really think much of it. Then she asked about movement and I stopped in my tracks and said, "The baby hasn't moved much for a day or two" still didn't think much about it cuz that sometimes happens at the end of a pregnancy. I declined the U/S
One of the most horrific features of homebirth deaths is that other children in the family are often present to witness the birth of the dead baby, the frantic 911 call, and the transport to the hospital:
contractions started feeling pushy, but not great pushing... The baby was breech. No hard head to push against... Pushed hard as I could from 7-8. Pushing the head (with the arms both up against it) took three pushes. Albert caught up and put him on the floor. He did not move at all. He is blue. He really is BEAUTIFUL. I pick him up and rub his back. James (age 12) puts down the camera and calls 911. We flick Micah's feet. I blow in his mouth. I hear gurgling in the lungs. I get the fetoscope, I can not find the heartbeat. My neighbor (a volunteer EMT) comes over @ 8:06 AM (Micah born @ 8:00) and tries everything. a few minutes later the ambulance arrives... Neighbor stayed in ambulance with me and did chest compression on baby the entire way... When we get there they take Micah and wheel me into ER where they are inserting IV's and crap... While they are still hooking me up to stuff the NICU nurse comes in and says the were unable to get the baby to breathe. Seconds later my husband comes in with Micah. It was TERRIBLE. worse moment of my life. I held it together really well. I *knew* from the moment I saw him that he was gone. Albert took it harder @ this moment. I never want him to have to go through this ever! ...
Perhaps UC should take a new motto: Trust birth, have a dead baby.
The death of any baby is a tragedy of major proportions. The possibility that the death was preventable by routine obstetric care makes it an even greater tragedy. Did trusting birth prevent this baby from being breech? No. Did trusting birth mean that it is appropriate to ignore decreased fetal movement? No. Did trusting birth make refusing an ultrasound a good idea? No. Did trusting birth prevent this baby from suffocating to death inside the uterus? No. What did trusting birth accomplish? The same thing it always accomplishes: NOTHING!
It is not clear at this point what caused the baby's death and if the baby had anomalies, it might have died in spite of medical treatment. However, that is not a reason to decline appropriate medical care. This baby might have died of entirely preventable causes, or it may have died of causes that could have been treated in the hospital. At a minimum, appropriate medical care would have alerted both parents and providers that something was wrong, and might have spared the other children the horror of watching the birth of a sibling that, entirely unanticipated, was dead.
Labels: homebirth death
Another homebirth; another baby dies a preventable death
A blog reports on the death of a friend's baby at homebirth (http://mommytoamonkeyandaprincess.blogspot.com/2008/05/katarina-didnt-make-it.html):
Then my phone starts beeping again. There is a text message ... "Call Holly regarding Brandy's baby"
I put the phone back to me ear and hear prolapse and ambulance and Baylor...
Holly responds "Brandy is fine," and there is a long pause... "Katarina didn't make it."
I didn't want to believe Holly, I knew that I imagined that horrible little word. That nasty stupid measly three letter word. That sweet little baby that was supposed to come out and be big and healthy and gorgeous couldn't be gone... I'm scared to death that some insensitive soul is going to say that it is because she chose to home birth. I want to protect them from any mean looks or words but I'm probably not going to even be able to do that.
Labels: homebirth death
New study showing high homebirth death rate is poorly done
I often complain about the fact that there is a lot of poorly done research in medical journals. That's why it is important to read the study, to determine if the conclusions are justified by the data. Here is a new study that purports to show that homebirth has a rate of intrapartum death that is high and rising. It is certainly possible that this is the case, but the study is based on so many unproven assumptions as to be essentially worthless.
The study is
An estimation of intrapartum-related perinatal mortality rates for booked home births in England and Wales between 1994 and 2003 by Mori et al. in the April issue of the British Journal of Obstetrics and Gynecology. According to the authors:
Results: The overall IPPM rate for England and Wales improved between 1994and 2003. However, data to obtain a precise estimate of IPPM rate for booked home birth were not available. The average IPPM rate for all births in the study period was 0.79 per 1000 births (95% CI 0.77–0.81), and the estimated IPPM rate for booked home births was 1.28 or 0.74 per 1000 births, depending on the method of calculation (range 0.49–1.47). The IPPM rates for the completed home birth group appeared to be lower throughout the study period compared with the unintended home birth groups. Those women who had booked for a home birth, but later needed to transfer their care for a hospital birth, appeared to have the highest risk of IPPM in the study period.
Conclusions: The results of this study need to be interpreted with caution due to inconsistencies occurring in the recorded data. However, the data do highlight two important features. First, they suggest that IPPM rates for home births do not appear to have improved over the study period examined, even though rates did so overall. Second, although the women who booked for home births and had their babies at home seemed to have a generally low IPPM rate, those who required their care to be transferred to hospital did not. Women who book for home births should be offered comprehensive evidence-based information about the potential benefits, risks and uncertainties associated with their choice of birthplace by the healthcare professional responsible for supporting their decision. It is of considerable concern that the data recorded nationally in England and Wales do not provide accurate information about when and why a transfer from home to hospital booking occurs and about their outcomes.
These conclusions could be true, but the paper does not show that they are true. Indeed, the paper does not show much of anything.
In reading the paper, you should keep in mind that the authors use a new statistic, intrapartum
related mortality.
IPPM rate is defined as deaths from intrapartum 'asphyxia', 'anoxia' or 'trauma', derived from the extended Wigglesworth classification 3, which is used by CEMACH. This includes stillbirths and death in the first week. The denominator was all births (live births and stillbirths).
What they appear to mean is perinatal mortality caused by intrapartum asphyxia. I have not seen this statistic used before in any other homebirth studies.
The initial comparison is straightforward: "A total of 4991 intrapartum perinatal deaths occurred in England and Wales between 1994 and 2003 among 6 314 315 births" for an IPPM rate of (0.79 per 1000 births [95% CI 0.77–0.81].In contrast, "[t]here were 125 intrapartum-related deaths among the 130 700 home births in England and Wales in this period" for an IPPM rate of 0.96 per 1000 births (95% CI 0.79–1.03).
Now comes a gigantic problem, or rather two gigantic problems. First, the homebirth group includes both planned and UNPLANNED homebirths (rather like the Pang study). Second, the homebirth group does NOT include women who planned to deliver at home but transferred to the hospital. Therefore, you cannot draw any valid conclusions from a direct comparison.
Here's where the authors get into trouble. As an
editorial accompanying the paper explains what they did:
Mori et al. attempt to compensate for this by using figures for the proportion of deaths associated with planned and unplanned home births collected since 1994 by the Confidential Enquiry into Maternal and Child Health. Furthermore, they impute from previous smaller studies in various parts of England and Wales the proportion of home births planned to be at home but transferred to hospital because problems had developed in labour (this group also has a poor outcome). This enabled the authors to make an estimate, with confidence intervals, of the likely perinatal mortality associated with an intention to give birth at home. Although this should be a selected low-risk group, their perinatal mortality between 1994 and 1997 was no lower than that of hospital births and subsequently was consistently about 80–250% higher (significantly so in 1998–99 and 2002 03).
In other words, in order to arrive at their calculated intrapartum related mortality rates, the authors estimated BOTH the denominator (the number of intended homebirths) and the numerator (the number of deaths that purportedly occured in the estimated intended homebirth group).
When the authors claim that the purported intrapartum related mortality rate in the intended homebirth group is 0.96/1000, they are really saying this:
125 deaths + estimated transfers deaths - estimated unplanned homebirth deaths
______________________________________________________________ = 0.96
130,700 births + estimated transfers - estimated unplanned homebirths
That could be true, but since four out of the six variables are only crude estimates based on past data, it is just as like to be false. It could be lower, or it could be higher; there is absolutely no way to know. Moreover, since the numerator is so small, even tiny errors in estimation will have a big impact on the result.
The only part of the paper that we can be certain is accurate is this:
It is vital that data are collected prospectively so that an accurate picture can be established of both intended and unintended home birth rates, together with a clear indication about when and why a transfer to hospital care occurred. The fact that reliable data are not currently available to inform a key health debate is a matter of great concern.
Fortunately, a study is underway to correct this deficiency. The National Perinatal Epidemiology Unit in the UK is currently collecting data for the
Birthplace Study, which is "designed to compare outcomes of births planned at home, in different types of midwifery units, and in hospital units with obstetric services." The results should be available next year.
Labels: homebirth death, neonatal mortality
The most pernicious lie
Homebirth advocates react very poorly when confronted with reality, and there's nothing more real than a death at homebirth. When face to face with a homebirth death, it's difficult to respond with platitudes about "trusting" birth, so instead, homebirth advocates and homebirth midwives respond with a particularly pernicious lie. That's what's going on over at MDC now.
A woman who is pregnant is trying to decide where to have the baby. She lost her first child at a homebirth "in the last few minutes of pushing before delivery. I had a longish but normal labor and about 3 hours of pushing - nothing out of the ordinary for a first timer. I had a pair of wonderful CNM's and my daughter was at the hospital ER within 10 mins. I will never know what happened as no autopsy was performed. She was seemingly a healthy girl until she died unexpectedly."
Other women offer condolences and then most go on to repeat the pernicious homebirth lie that this happens in the hospital all the time. Nashvillemidwife, spouting typical homebirth midwifery ignorance, posted this inane comment:
Babies die in the hospital like this every day... Even if you had been strapped to a continuous fetal monitor there is a good chance they would not have gotten you prepped and cut in the 10 minutes it took for the midwives to get her delivered at home.
No, nashvillemidwife, babies do not die in the hospital like this every day. In fact an intrapartum death is rare, and an unanticipated birth of a dead baby is almost unheard of. As I have described previously, I worked at major urban medical centers over a period of more than a decade during which approximately 75,000 babies were born. I never saw anything like this and I only heard of it happening just once, and that was considered a scandal that resulted in an investigation and reprimand of the provider.
Moreover, nashvillemidwife appears to be unaware of the basics of fetal heart rate monitoring and unaware of the procedure for handling severe fetal distress late in the second stage. First, babies don't simply drop dead. A cardiac arrest is the last stage in a long sequence of events accompanying fetal hypoxia. There almost certainly was an abnormal fetal heart rate for quite some time before the terminal event, but either the midwives did not monitor it, did not listen long enough, or did not understand what they were listening to. Had the mother labored in the hospital, the fetal distress would have been picked up long before the baby's heart stopped, and the baby could have been delivered then.
Second, when fetal distress is diagnosed late in the second stage, the baby is delivered NOT by C-section, but by vacuum or forceps. It takes only a few minutes to perform a vacuum delivery, there is no special preparation necessary, and the mother does not have to be moved to an operating room.
Third, when the baby was born at home, there was no one present who could perform an expert neonatal resuscitation, and that could have made a big difference. Intubation, CPR and heart stimulating medication might have been able to resuscitate this baby.
The baby is dead and nothing can change that. However, the tragedy should not be compounded by papering it over with lies. Rather than prattling nonsense, nashville midwife and other homebirth advocates should take the opportunity to learn from this tragedy.
Labels: homebirth death
New report shows increase in perinatal deaths at homebirth in Western Australia
A
press release from the Department of Health of Western Australia celebrates declining rates of perinatal and neonatal mortality in the years 2002-2004. Despite the overall improvement, specific problems were identified:
Dr Towler [Chief Medical Officer] said the report had raised three key areas of concern - the role of socioeconomic status and smoking as risk factors for stillbirth and infant death, the continuing high mortality rate of Aboriginal babies, and the relatively higher mortality rate of babies born at term to mothers who had chosen a home birth.
The unanticipated perinatal deaths at homebirth in 2002-2004 followed on the heels of unanticipted perinatal deaths at homebirth from 2000-2002. Accordingly, the Department of Health attempted an in depth review as part of its
12th Report of the Perinatal and Infant Mortality Committee of Western Australia:
There were a total of six unexpected term perinatal deaths
amongst planned home births recorded in the five years Jan 2000 – Dec 04. The six deaths occurred between 38 and 41 weeks gestational age, and involved singleton pregnancies with no overt congenital abnormalities. Two deaths were antepartum and four were the result of an intrapartum complication (two stillbirths and two early neonatal deaths). Three of the deaths occurred at home and three occurred in hospital. One of the six babies delivered at home, and five delivered in hospital. Four of the six cases had low-level medical preventability scores (2 or 3) and two cases had no evidence of preventability.
The term perinatal mortality rate was 6.7 per 1,000 total births, compared with a term perinatal mortality rate of 2.1 per 1,000 total births in the planned hospital births in the same period, which was a statistically significant difference (Fisher Exact p=0.013)...
Trend data show that the proportion of planned home births has remained fairly stable at between 0.4 – 0.7% of all births over the past 15 years.
The Committee reached the following conclusions about homebirth:
A small but significant number of women choose a planned home birth. Ideally that choice would be 'informed choice'. The current risks and benefits of home birth in Australia are not well understood, due to low numbers and lack of recent research. However, there was an increased risk of perinatal mortality in planned home births compared with planned hospital births in a large Australian study of home births where analysis of births in the four years 1985-1988 for which the most comprehensive data were available showed that in babies of at least 2500g birthweight there was a perinatal mortality rate of 5.7 deaths per 1000 births in planned home births compared with 3.6 deaths per 1,000 planned hospital births. Intrapartum death not associated with congenital malformation or extreme immaturity was three times as frequent in planned home births than it was nationwide...
Advocates of home births have often quoted 'safety data' from international studies, but it is difficult to extrapolate from international data to the situation in Australia where there are differences in many respects, including training and experience of midwives, and geography. The difficulty of emergency transport services to offer safe retrievals in WA is a major consideration. Whilst there have not been any maternal deaths in planned home births in WA in recent years, there may be concern about the potential risk of maternal death, particularly due to postpartum haemorrhage in the home setting. There was a significantly increased risk of third stage complications in planned home births in WA 1981-1987.
The information presented from the WA 2000-04 analysis shows that the choice of home birth would appear to have put 'low risk' women into a ‘higher risk’ category of perinatal death,.. (my emphasis)
This report emphasizes the fact that there is NO scientific evidence that shows homebirth to be as safe as hospital birth. The report itself is yet another contribution to the burgeoning literature that demonstrates an increased risk of perinatal death at homebirth.
Labels: homebirth death
Ultimate quote
"I don't think you failed at UC because your baby didn't make it."
That's a real quote from my favorite homebirth board. Allow me to disagree:
Actually, you DID fail, in the most spectacular, self absorbed and irresponsible way possible. Birth, like any aspect of caring for a child, is not a piece of performance art; it is just one aspect of a deep and abiding responsibility to put the well being of your child above all else. When your baby dies because you chose UC, not only did you fail at childbirth, you failed at parenting. Own that failure, take responsibility for it and let others know that UC kills babies.
There is a new thread on the board entitled "It drives me insane". The poster is decrying the fact that some doctors recommend a C-section for babies who are estimated to weigh over 10 pounds. When I read the first post, I expected responses that would question the scientific evidence for inducing babies to prevent shoulder dystocia. I was utterly shocked to see this:
... DD was 10 lbs-- when I went in at the beginning of my second pregnancy they tried to schedule me a c-section right then and there to prevent a "too big baby". Uhm, how bout NO!
What's shocking about that? She does not mention that her daughter died because of shoulder dystocia at UC. Her doctor is recommending a C-section because women who have a severe shoulder dystocia in one pregnancy are at much greater risk for having the same thing happen again in a subsequent pregnancy.
Women who are contemplating UC or even homebirth, need to be incredibly wary of taking recommendations from women who consider vaginal delivery more important than the life of the own child. Their self-absorption, in the abstract, before the baby is born, is appalling. However, many of these women are suffering from lack of knowledge or denial. They simply don't understand or believe that their baby could die.
It is incomprehensible that after a baby's death from shoulder dystocia, UC advocates, without the least bit of self consciousness or shame, could mock efforts to prevent death from shoulder dystocia.
edited @11:42 AMLabels: homebirth death
The dead baby card
Jill at
Keyboard Revolutionary finds it "amusing and frustrating" when people "pull out the dead baby card."
I don't find it amusing; I find that it is generally worth taking notice. What exactly is "the dead baby card, anyway?" Jill seems to think that it is telling women that their baby is at increased risk of death even though that is not the case. What Jill and most homebirth advocates don't seem to realize is that they literally have no idea about the existence or the magnitude of the increased risk of perinatal death. Not only do they not know about the increased risk; they actually parade their ignorance while congratulating themselves on being "educated".
Take Jill's comments for example:
"You're not going to do the glucose test? Your baby will die!"
Gestational diabetes DOES increase the risk of perinatal death. Untreated gestational diabetes increases the risk of perinatal death even further.
"You're not going to be induced if you go past 40 weeks? Your baby will die!"
The perinatal death rate DOES increase every day beyond 40 weeks. We have set an abitrary cut off at 42 weeks when the death rate has essentially doubled, but it has been rising steadily every day of the previous 2 weeks and continues rising every day thereafter.
"You're having a homebirth? Your baby will die!"...
Homebirth DOES increase the risk of preventable neonatal death. All the scientific evidence to date shows that it increases the risk of preventable neonatal death approximately 1-2/1000 ABOVE the hospital neonatal death rate.
"You're not getting him his vaxes? Your baby will die!"
Rejecting vaccination DOES increase the risk of death from vaccine preventable illnesses.
Of course Jill, like most homebirth advocates who lack an understanding of even basic statistics, makes the typical homebirth advocacy mistake. She assumes that when doctors inform people that something increases the risk of death, that means the risk of death is 100%; and if the risk of death is 100% and the baby doesn't die, then the doctor was wrong. However, increasing the risk of death means just that: it is increased over what it was before. It might be double, triple or 10 times higher. It does not mean that the risk is 100% or even 10%. When the risk is increased, that does NOT mean that a baby is guaranteed to die. That does NOT mean that if the baby doesn't die the doctor was wrong. It simply means that if you group together all the people in the higher risk group, their babies have an increased risk of dying compared those in the low risk group.
It's like carseats. If you drive to the store and don't put your baby in a car seat, it does not mean that your baby will die. And if you baby doesn't die on the way to the store, that does NOT mean that the benefits of carseats have been exaggerated. The mortality rate of a baby not strapped into a carseat is not 100%; it is simply higher than the mortality rate of a baby who is strapped into a carseat.
Jill goes on to illustrate an irony of homebirth advocacy.
Really, now, what mother in her right mind WANTS her baby to die? Look at all the fun stuff we have to abstain from just to ensure that we cook a healthy baby!
We can't smoke, drink, or take drugs. We can't eat undercooked meat, certain kinds of fish, or soft cheeses. We can't dye our hair. We can't ride rollercoasters or mechanical bulls. We can't take a dip in a hot tub. We can't drink coffee or soda. We can't put artificial sweeteners in our tea. We can't take ibuprofen, or any legitimate pain reliever for that matter, since Tylenol is the only option, and Tylenol really sucks. We can't take most cold medicines if we get stuffy. In a nutshell, we can't do a whole lot of stuff that we'd normally enjoy, all for the sake of our unborn baby.
Those risks are actually LESS than the risks that homebirth advocates dismiss as playing the "dead" baby card.
What's the neonatal mortality rate of hair dying? It's zero. How about riding roller coasters, drinking coffee or drinking soda? Zero. What about artificial sweetners? Zero again.
Personally, I find it "amusing and frustrating" that women who obsess about theoretical risks of drinking coffee and soda during pregnancy casually dismiss REAL risks of increased rates of perinatal death as playing the "dead baby card."
Labels: homebirth death, neonatal mortality
