Tragedies Highlight Risks of Homebirth

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Last week in Australia, Caroline Lovell, a home birth advocate. died the day after childbirth. Blogger Mia Freedman reports on the story and adds:

When I went to look for information on the death of Janet Fraser’s baby during her freebirth, I found that all the threads on the freebirthing and homebirth forums that dealt with bad outcomes (including the death or injury of the baby or mother) were locked and not visible to the public who were only able to read the happy health birth stories.

So a blog reader caught my attention a few days later when she shared a link about the death of baby Magnus (pictured) in a birthing center. Some birthing centers that offer midwifery care are directly overseen by a hospital. But Magnus’s mother Sara only realized afterward that her son’s birth was the equivalent of a home birth, only in someone else’s home. There was no supervision at all, only a loose connection with an OB.

Sara and her husband became concerned because of the baby’s breech position at 38 weeks. Sara had thought that the birth center didn’t do breech births, but the midwives assured her it was perfectly safe:

I asked her specifically what she would do if indeed he did end up getting stuck and her reply was, “She’d have to get him out.” She told us that breech babies are, “Just a variation of normal and that as long as there wasn’t anything odd or troublesome that delayed labor, then we could have the baby there and not be transferred to the hospital.” That’s it. No discussion of what could go wrong, no indication that it could turn out in such a devastating way as it did. We did not fully understand the severity of risk we were taking on.

After reading Sara’s heartbreaking story, I decided to read the ten other entries in the blog, Hurt By Homebirth. The blog was founded by Dr. Amy Tuteur, a Harvard-educated obstetrician and well-known anti-home-birth activist. She started Hurt By Homebirth to give parents a chance to tell their stories, in their own words, in a safe place where they would not be attacked by home-birth advocates.

What shocked me about the homebirth stories is that in nearly every case, the baby’s death or injury was related to common factors like placenta previa or Group B strep. These conditions are generally prevented or treated with proper prenatal and obstetric care, but the midwives either overlooked the conditions or treated them with unconventional methods.  Also, the mothers and babies were not transferred to the hospital in time. Reading these stories illustrates how quickly things can go wrong. It appears that the quality of private midwifery care varies widely, and it’s difficult to get accurate information about a particular midwife’s qualifications and success rates.

As a blogger who has shared more than one story about poor care in hospitals, I believe it’s important to be aware of dangers of improper or incompetent care both inside and outside of hospitals.

As Sara wrote in a Facebook comment (using her husband Jarad’s account),

” . . . when you start talking about agendas and skewed statistics, it goes both ways. That was absolutely our experience with the extremist philosophies of our midwives that directly impacted our care in the face of crisis. It is also our experience trying to seek accountability through NARM and MANA. This is not a one sided issue, it is about defining a way in which families are not put in the middle of two opposing systems, but finding a way for them to work together for the best interest of all of us. Example: British Columbia, Netherlands who take licensing standards seriously, help their midwives be insured, and work both in and out of hospitals . . . and oh by the way, report their outcomes.”

Condolences to Sara and Jarad on the tragic loss of their son, Magnus. I hope and pray that sharing their painful story will lead to improved care for future mothers and babies.

Related:

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Covering Up as a Health Issue: A View from Sweden

Guest Post: Miracles of Motherhood

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Comments

  1. I think the bottom line is that you have to find caregivers who are committed to mom & baby being safe before any other agenda. Oftentimes, that means little intervention, but sometimes, it means giving an epidural and pitocin or even doing a c-section. There’s no question that many hospitals put other factors ahead of healthy mom & baby, but unfortunately, the stories about the birthing centers show that there are those on the other side who are also pushing other agendas.
    I feel very fortunate. My experience with Israeli hospitals is that they offer minimum treatment as long as labor is progressing well and there is no maternal of fetal distress, but they have the rooms set up and the specialists at hand so that if an emergency occurs, they have how to deal with it quickly and safely. One amazing case I know of was a case where the fetus was in distress, so they ordered an emergency operating theater. While the mother was being wheeled into the operating theater, the midwife continued to work on her, and was able to deliver the baby in the OR at the absolute last minute.
    LeahGG recently posted..Braving the SupermarketMy Profile

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  2. Giving birth is dangerous business no matter where you do it. We are lucky to live in a time when this is the rare exception. The cases that I read on Hurt By Homebirth were tragic but I bet you could have a blog called Hurt By Hospital Births that would be many times larger. There are unfortunately bad health care providers out there.

    I know many, many women in NYC who have had good safe home births. They all had Certified Nurse Midwives attend their births. The only two infants that have tragically died that I personally know of (I knew the mothers) were both in hospitals and both not considered to be high risk.

    Hot debate. What do you think? Thumb up 5 Thumb down 3

  3. I agree with Beth. These stories are certainly tragic, and while I didn’t read the full stories from the blog you mentioned (too sad; can’t stomach), it does sound like there is a lot of irresponsible stuff going on in the home birth world. But I don’t see the educational purpose of these stories – of course there are some tragedies, both in hospital births and in home births, because giving birth is dangerous. Really what I’d prefer as a basis for decision-making would be studies about the relative safety of home vs. hospital, but those all seem to be controversial too.
    I also think that it’s really crucial for mothers to be informed no matter what method you choose. If you are giving birth in a hospital (as I did, once in US and once here), you need to know c-section rates and how common other interventions are. It’s helpful also to know how various complications will be dealt with. Similarly if you’re planning a home birth, you need to know what your midwife’s transfer rate to the hospital is, and how she would plan to deal with various complications. When my sister planned a home birth in NYC, she was very reassured when her midwife told her in the first interview that she had never (or maybe very rarely) done an *emergency* hospital transfer – her (relatively frequent) transfers to the hospital happened long before the point where it became an emergency.

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    • Nurse Yachne says:

      “didn’t read the full stories from the blog you mentioned (too sad; can’t stomach)”

      Like they say, “Denial is not just a river in Egypt.”

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      • I also never saw “Escape from Sobibor”; does that make me a Holocaust denier?

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        • Nurse Yachne says:

          Faulty analogy, unless you’re planning to time-travel back to 1940′s Poland.

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          • Ok let me be direct about this. I don’t know you and maybe you are just someone who likes to say insulting things to strangers on the internet and I shouldn’t read much into it. but it’s also possible that your comment reflects a perspective that some people have nowadays that unless you read every lurid story on every single blog and look at every lurid picture that everyone posts of murder victims or stillborn babies, you are somehow avoiding reality. I think this notion is warped and voyeuristic. I do not believe that exposing yourself to every personal tragedy out there – and there are many – makes you a more sophisticated or even more knowledgeable person.

            Like or Dislike: Thumb up 4 Thumb down 2

  4. I read the entire blog too. I also came to the conclusion that these families were not hurt by home birth, but by incompetent care givers. It could all have been avoided. I am not advocating home birth, but the blog only shows one aspect of it. I always gave birth in hospitals.

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  5. At times the hospital may be “unpleasant” but when you have an emergency, it’s a lot safer than at home. I’ve always liked the fact that in Israel, even over 40 years ago when I had my first child, there was one room for birthing mothers and we weren’t wheeled from a labor to a delivery room at the most dangerous part of labor. Just to think of having to get an ambulance in an emergency makes a hospital birth worth the hassle. Today the hospitals allow much more freedom to the mother, dulas and family etc.
    I wouldn’t choose homebirth.
    Batya recently posted..More To Come From The Shiloh’s 34 PartyMy Profile

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    • “I’ve always liked the fact that in Israel…there was one room for birthing mothers and we weren’t wheeled from a labor to a delivery room at the most dangerous part of labor”

      Not sure what this means – in both Ein Kerem and Sharei Tzedek there’s a room with 6 labor beds, and the mother is wheeled into a delivery room when she’s much closer to delivery.

      Could you please explain?

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      • I think that different hospitals have different policies. I gave birth in Barzilai, Ashkelon (4) and Ma’anei HaYeshoua, B’nei Brak (1). I walked from a receiving room to a delivery room in four of the births and the only one in which I didn’t had extenuating circumstances. I had been admitted to the hospital (Barzilai) early for observation and the delivery rooms were overcrowded so by the time I could be admitted to a delivery room I had to be wheeled in, but there was still plenty of time before I actually gave birth.

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      • Melanie, there is the kabala and there are “anterooms” for women who need to get pitocin going (i was in one of them for my last birth) but generally, if you come to the miyun and you’re over 3 centimeters and in active labor, you go right into the L&D room.

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      • I work in the labor ward of Hadassah Ein Karem and we have no such room. We have a triage area where up to 5 women can be assessed at a time, in curtained-off cubicles, but a woman is admitted to the labor ward well before she is imminently giving birth.

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        • Right – the woman is in the triage room until she’s in the later stages of labor or until a bed opens up, but unlike the American system where women are in a labor area until almost the very end, it’s quite common to spend 5 hours or more in the delivery room laboring before the birth. Not that I had that luxury. For my first, I got a room 2 hours before delivery and never got an epidural despite having been in the hospital for 6 hours before delivery. And with my second, I got a room almost as soon as I got there along with the promise of an epidural very soon. My urge to push arrived before the anesthesiologist – to be fair, I gave birth 40 minutes after arriving in the hospital. This is why I tell mothers that they need to be aware of their options, but realize that their body is in control, not them.

          I’ve also heard from several mothers that they don’t want an IV when they’re in labor. Really? Like the tiny little needle prick is what bothers you when you feel like your whole middle is about to explode? Personally, I thought it was nice to end my delivery not dehydrated… and in the last hour or so each time, I couldn’t eat or drink anything. (Though I had a double burger and fries while I was in labor with my first – but that was like 10 hours before the birth) YMMV
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          • American hospitals don’t use separate labor and delivery rooms now–the model is the LDR (labor-delivery-recovery) or sometimes LDRP (labor-delivery-recovery-postpartum, a model that takes more space because you can’t move from a big LDR to a small PP room).

            I didn’t labor with either of mine, but I believe you’re triaged if you come in in labor, and are admitted and sent to an LDR(P) when judged to be in active labor. If you’re not, they send you home. If they’re very busy, you might wait in triage, just like in Israel. You deliver in the LDR, and if it’s not an LDRP you’re shifted to a postpartum room a few hours after birth, when judged to be stable. (With #2, a scheduled CS, I did my prep and recovery in an LDR; I spent 3 or 4 hours in after surgery, being monitored.)

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  6. Please note that Caroline did not die in childbirth. She went into cardiac arrest during childbirth and was still alive but in critical condition when the paramedics arrived. She was then rushed to a hospital where she died the next day.
    http://www.iol.co.za/lifestyle/family/birth/home-birth-advocate-dies-in-home-birth-1.1225581

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    • Captain Obvious says:

      That is like saying she didn’t die in the car accident, but was rushed to the hospital and died the next day. We don’t know what caused the cardiac arrest. Was it a hemorrhage that could have been better managed in the hospital? Was it elevated BP that wasn’t monitored? Or was it just bad luck. We don’t know if she had delivered in the hospital and had a cardiac arrest, could have a more rapid response to treatment have saved her life. Maybe the delay of getting her to the hospital along with the decision to deliver at home have contributed to her death.

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  7. There is a reason why birth is considered pikuach nefesh.

    Things can go wrong very quickly and without notice. I had major complications several hours after one of my births (which went very smoothly and left me feeling great). I am not sure I would still be here had I not been in a hospital.

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  8. While I don’t put much stock in home birth horror stories as evidence that home birth is less safe than hospital (because I don’t know how they compare to the number of hospital horror stories), I put even LESS stock in “I would have died if I hadn’t been in the hospital” stories. Most people who say that have not gone over their medical story with someone knowledgable about home birth, and are simply imagining that home would have been exactly the same as hospital until the point at which the emergency happened.
    For example, some studies show that incidences of postpartum hemorrhage are lower in home births than in comparable populations giving birth in hospitals. If this is true them when a woman who gave birth in a hospital and nearly died of a postpartum hemorrhage cites her story as an example of how the hospital saves lives, she may have it backwards; it may be that she would have been fine at home and that in fact the hospital nearly killed her.
    I’m not saying that home birth is in fact safer; only unbiased studies can really prove what is safer, and those seem to be few and far between. I’m just pointing out a common fallacy in the reasoning many people use to attack home birth.

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    • Channa, you are missing my point. I can share plenty of hospital horror stories as well, and I did not quote studies. The problem here is not homebirth per se, but incompetent and negligent midwives who should be put out of business. I was shocked to find out how little regulation of homebirth there is in some parts of the US. And perhaps here in Israel too.

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      • Sorry I wasn’t responding to you, but to the commenter before me who made the common (flawed) argument that hospital birth is safer because she would have died if she hadn’t been in the hospital.

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      • Ms. Krieger says:

        @amotherinisrael, regarding “putting incompetent midwives out of business”

        Much of the problem in the US is political. Quite a few states in the US refuse to license midwives to practice medicine. If they don’t license them, they can’t regulate them, except to put them in jail if they are caught practicing medicine without a license. Other states (for example, Virginia) will put onerous restrictions on midwives who are licensed. Not allowing them to carry potentially life-saving drugs such as oxygen or pitocin, for example. So if a midwife in Virginia agrees to be licensed, she is then morally obligated to obey restrictions under the license that could put her clients’ health at risk. So many midwives refuse to be licensed in Virginia and practice outside the law.

        So being licensed is no guarantee of quality, as they say. It’s a bad situation here.

        (Note that midwives are trained and certified by their own organizations, just as OBGYNs are trained and certified by their own organizations. States then license doctors and midwives with credentials the state decides to accept. I don’t know how this process works in Israel, or Australia.)

        If all states in the US licensed midwives with appropriate credentials, it would be easier to regulate their practice, the way doctors are regulated.

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  9. this is the first reported home birth death in australia in 20 years… while at least 20 babies have died in hospital births in the last year in Australia.
    I recently read a story about co-sleeping death in the states … and all the people were screaming about how dangerous co-sleeping is etc. etc. but not one person mentioned how many babies die of sids alone in a crib !!!

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    • Maybe because they are transferred to the hospital in time for the death to be in the hospital?
      Or maybe in Australia the midwives know what they’re doing, and don’t wait for things to get dangerous before they transfer. A midwife attending a home birth should be on a hair-trigger to transfer as soon as anything is even slightly amiss. In every case listed on the blog, the midwives waited too long – knew things were wrong and kept going, etc.
      I have a friend who was committed to having a home birth – she went to a special home birth ‘tzimmer’ and everything. The birth didn’t go correctly, and she ended up delivering in a hospital. Both she and the baby were fine. Her midwife was apparently more worried about the lives involved than the politics involved… Thank G-d, and thank that midwife.

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  10. Recently , we had a tragedy here in Petach Tikve where a woman doctor was giving birth and died in childbirth due to a complication – fluid went in the opposite direction – lungs

    parents have to make the effort – histadlut – and pray that all goes well and we get all the help including si’ata dishamaya

    Allan
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  11. “Giving birth is dangerous, no matter where you do it.”

    Exactly. This is one of my per peeves about many home birth advocates. They keep on insisting that childbirth is “natural” and “normal” and therefore not dangerous. That’s nonsense. A lot of “natural” things are highly dangerous.

    Before anyone jumps down my throat, I KNOW that this is NOT the case with ALL advocates. But, it’s all too common – that’s why homebirthing boards lock / hide threads that discuss poor outcomes.

    Just as I think it’s well past time for the medical profession and hospitals to start dealing realistically and responsibly with the issues and risks presented by common practice (and mal-practice) in obstetrics, it’s important for home birth advocates to deal reasonably and realistically with the issues and risks presented by home births.

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  12. Nurse Yachne says:

    “…maybe you are just someone who likes to say insulting things to strangers on the internet…unless you read every lurid story on every single blog and look at every lurid picture that everyone posts of murder victims or stillborn babies, you are somehow avoiding reality”

    Someone who takes the responsibility of giving birth at home ought to know that this choice may have serious consequences. It isn’t “fun” knowing and being aware of what can go wrong, but not knowing and not taking responsibility does *not* protect anyone from the risks you take.

    Hospital birth in Israel has becme very responsive to the desires and demands of the birthing public. Why should an educated, aware, and resopnsible mother risk the health and life of her child for the sake of her own “convenience”?

    Modern medical science in the service of the consumer is a beautiful thing.

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    • I agree that you need to be informed and take responsibility. If you had read my entire original comment you would have seen that in fact I said exactly that. (I also mentioned that I personally had my babies in hospitals.) The crucial difference is that I do not believe that reading a blog with horror stories is the way to become better informed. Do not confuse anecdotes with information. Making medical decisions based on a blog with personal stories would actually be quite an ignorant way to decide.

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    • Ms. Krieger says:

      @NurseYachne

      Home birth is not about convenience. It is about the safety, dignity, and physical integrity of women and their children. I am glad that some hospitals in Israel allow women to keep their dignity and physical integrity, and keep them safe. That is not the case everywhere. And even if it were, women still have the right to give birth where, how, and with the attendants they see fit to have with them. I agree that birth is risky, and that death is always a possibility. This is true whether you are in a hospital or in your own bed.

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      • Nurse Yachne says:

        Dignity and phyiscal integrity are good things, but they are secondary to physical safety. Hospital birth (and hospitals in general) frequently override the first two in single-minded pursuit of the third.

        To work in a clinical setting for any period of time is to realize that, yes, the unexpected “horror story” WILL occur given a large enough statistical sample. It is NOT, however, caused by reading about it or by being “morbid”.

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        • You say “Dignity and phyiscal integrity are good things, but they are secondary to physical safety. Hospital birth (and hospitals in general) frequently override the first two in single-minded pursuit of the third.”

          However, in over-riding the first two, the stage is all too often set for DECREASING the the third, not the reverse.

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          • Nurse Yachne says:

            “However, in over-riding the first two, the stage is all too often set for DECREASING the the third, not the reverse.”

            If that’s what you think, I would venture to say that you haven’t been in many medical emergency situations.

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