Monday, February 25, 2008

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.


0 Old Comments: