Wednesday, April 15, 2009

How Safe is Your Home Birth?

Last night I read my friend Jessica's post on a home birth turned tragedy, and immediately replied that I'd weigh in on it today.    The tragedy, the death of a baby born in an unassisted, unmonitored home birth.  So, here I am.

As a neonatologist, my profession, my passion is taking care of critically ill babies, most of whom would not survive without medical assistance.  I live in the world of the <1% of births that go really wrong. Approximately 10% of babies require some assistance at birth, included in that number is the ever increasing percentage of preterm births. And yet still many argue that we are "medicalizing" a process that is natural and  has occurred without medical assistance for thousands of years.  True, but for those same thousands of years there was generally a midwife or some trained person who assisted the the delivery.  Further, for those same thousands of years childbirth was the number one cause of death for women and babies.  Like I said, I live in the world of 1%.  I have seen crazy things.  There is one case that is burned into my mind of a home birth where the mom refused to listen to the midwife and her husband and go to the hospital when things started to go wrong.  After the woman passed out, the midwife drove her to the hospital, the baby was delivered, saved, but left neurologically devastated because of waiting too long.  A few hours earlier, they might have had a healthy baby.  The list is long and bad things happen even under the best of care, but wouldn't you want a chance to intervene if things start to go wrong, a chance for the baby and the mom.

 Reading the article about this woman in Australia it is clear that her labor was not going as planned, that she had to have an emergency c-section for her first child makes it even less safe for her to be completely unmonitored and unassisted. That she labored for 5 days, something no physician or midwife would allow, especially with the risk of uterine rupture after a prior c-section.  That the baby is dead is a tragedy.  Could medical intervention definitely have changed the outcome, no.  However, it would have given this baby a chance.  

11 comments:

Jessica Gottlieb said...

"I live in the world of 1%."

YES!

Oh I'm so lucky I know you.

Classy Mommy said...

excellent post. both of my deliveries were in that < 1% scenario. thankfully, i had both children in a hospital setting although i still opted for natural childbirth. in both cases, had I been at home it is likely my children would have died. my labors were wonderful and normal and very fast - but the distress & issues came both times upon delivery in the final seconds of the birth when it is too late to get to a hospital. thankfully I have 2 healthy babies thanks to modern medicine. And I still had my natural childbirths too! great post.

elizabethonline said...

Thank you for sharing such a thoughtful and considerate response to this tragedy.

Adventures In Babywearing said...

I definitely think her situation was extreme and it's unfortunate when medical care CAN be sought but is instead refused. I had an easy homebirth, but had my midwife or even *I* suspected that any of us were in danger, to the hospital we would have gone immediately.

It's true- the outcome could have been just the same in the hospital as it was at home, but I definitely think you should seek help when you need it.

Steph

Rattling The Kettle said...

To really live in the world of 1%, you've got to consider the edge cases where hospital birth lead to tragedy (complications from unnecessary c-section; getting hit by a truck on the way to the hospital, whatever). Very rare. In fact, just as rare as attended homebirths for low-risk pregnancies leading to tragedy.

"Risk" is a function of statistics, not emotion or fear.

You've got to compare apples to apples. For low-risk pregnancies, a homebirth attended by a skilled midwife has no more risk than a hospital birth. A massive study just this week came out of the Netherlands confirming this.

You can't compare a hospital birth to an unattended homebirth, and extrapolate from that to all homebirths. Sure, unattended homebirths are MUCH riskier than hospital births. But it says nothing at all about midwife-attended homebirths.

Jessica Smallwood said...

As an RN and a mother, I completely agree. We have to be willing to forgo the "perfect" birth plan in order to deliver healthy babies. Our children deserve the best we have to give them. That is our duty as mothers. I, myself, had a scheduled C-section due to health concerns for both myself and my daughter. I have issues with the "natural" childbirth that so many people allude to. Your delivery is either vaginal or via C-section both are the "natural" way to bring your child into the world.

I am not against home births, yet I know that wasn't an option for me. Assisted home births can be a wonderful experience as long as mothers are making informed decisions with the health of the baby foremost as the priority.

Jessica Smallwood said...

As an RN and a mother, I completely agree. We have to be willing to forgo the "perfect" birth plan in order to deliver healthy babies. Our children deserve the best we have to give them. That is our duty as mothers. I, myself, had a scheduled C-section due to health concerns for both myself and my daughter. I have issues with the "natural" childbirth that so many people allude to. Your delivery is either vaginal or via C-section both are the "natural" way to bring your child into the world.

I am not against home births, yet I know that wasn't an option for me. Assisted home births can be a wonderful experience as long as mothers are making informed decisions with the health of the baby foremost as the priority.

Megan (mommyesquire) said...

I had a completely natural, comparatively easy hospital birth with my daughter. I would consider a monitored home birth with my next but never an unassisted home birth. I can absolutely understand the desire for a homebirth but when something is wrong, it is foolish to not seek necessary and available help. Why turn our backs on what modern medicine can offer us and give our babies the greatest chance?

agent99 said...

When are women going to understand that you don't get "extra points", or be a better mom for a more painful birth!!....it's all about what happens after the baby is out. The goal is getting the baby out health...wahtever that takes. My first child is handicapped, profoundly, as a result of a genetic disorder. Nothing anyone could have done could have prevented this tragedy; thus I feel strongly that whatever precaustions can be taken to avoid preventable losses are that much more important.

JaxMom said...

Wow. Some good discussion here. I had a perfectly healthy pregnancy, but ended up with a c-section after a breach baby. Somehow two docs and two nurses all mistook his hip for a head. I don't blame them, but was glad I was in the hospital when they figured it out.

Keep up the good posts, Lis.

theosmom said...

Awesome post, Lisa! I never understood a willingness to risk ANYTHING regarding the well being of one's baby re childbirth. Despite overwhelming stats in favor of a totally normal baby and delivery, I was always haunted by the big 'what if'....