WHHAAATT? Formula is a Fate Worse than DEATH?

Yes, that’s right. If that baby needs anything more than skin-to-skin contact and breastmilk, then you should apparently just let him die. I don’t know what’s more disturbing: that someone actually typed this out or that NINE  TWENTY ONE other people said, “Hey! I like that!”

(original post)

Only slightly less disturbing: the woman who thinks it might be reasonable to risk giving a special needs baby pertussis in order to donate breastmilk to him…

This is Batshittery.

Sorry, but there is no other word that accurately describes what is going on here. “Crazy,” or even “insane” don’t even begin to characterize this phenomenon. What is it?

That homebirth advocates continue to support Lisa Barrett. And every other dangerous midwife out there.

Who is Lisa Barrett? She is an Australian midwife who is currently the subject of a coroner’s inquest. On her website she recounts — with pride — birth stories full of high risk scenarios and obviously questionable judgement, ranging from… twins whom she allowed to deliver more than 48 hours apart (Story comes complete with a google search whereupon she came back to inform the expectant parents that the average time between delivery of twins is FORTY SEVEN DAYS. Even though most reputable sources and common sense report it as being 17 minutes.)… to a 35 weeker who didn’t begin breathing until TEN MINUTES after she was born… to a HBA3C with a previous vertical incision. Pictures of limp, blue babies abound.

On her site, she also claims 20 years of experience “within the system” and :

I am experienced in all types of birth and this includes birthing at home with babies in a breech position, twins and birth after caesarean. Anyone who believes they want and need this service should be entitled to get it.

So what does all this experience include and why is she facing a coroner’s inquest? It’s not because THE MAN is after her. It’s not because, as she claims in her plea for money at the top of her page, “the authorities are trying to censure homebirth via its most vocal advocates.”  It’s not “another witch hunt of a sister midwife.”

No, it is because this is a woman has attended at least four birth-related deaths since 2007. These are spectacularly horrific numbers, and who knows if they’re even complete. As much as homebirth advocates love to parrot the phrase, it just isn’t true that “babies die in the hospital, too.” Yes, they die of anencephaly or heart defects, but it is unbelievably RARE for babies who were perfectly healthy before labor started to come out dead or dying. But somehow, in Lisa’s case, they do. The first two deaths were HBACs and the last two were twin births.

  • Tate Spencer-Koch, born in July of 2007,  suffered a shoulder dystocia for more than 20 minutes and was unresponsive by the time she was finally delivered. The ambulance officers testified in court that Lisa hindered their attempts to get the baby into the ambulance and to the hospital.
  • In April 2009, Jahli Jean Hobbs was breech, became stuck, and was eventually born when Gemma Noone, A DOULA who was not supposed to have a role in the delivery at all, freed her arm, enabling her head to be delivered, but she was not responsive. It was all too late for little Jahli Jean.
  • In July 2011, Lisa attended the homebirth and death of an unnamed twin in Western Australia, which — in an amazing coincidence –also happens to be where Annie Bourgault lives.
  • On October 9, 2011, Lisa crammed with the mother and lifeless twin into the front seat of a car (Do they not have emergency transport in Australia? Or, perhaps, was it that she does not want ambulance officers testifying at the next inquest…) when complications arose after the home delivery of a first twin; the second twin was later declared dead at the hospital.
After the death of Spencer-Koch, Lisa attempted to argue  in the Australian High Court that the infant was never, in fact, a live  human being, and thus not deserving of a coronial inquest. The court disagreed and the inquest began. Throughout the hearings, Lisa continued to trumpet her contempt for the system and her victims by tweeting from the courtroom, including the chillingly ironic:
Yep. October 6.  Three days before the fourth death. Looks like “normal service” resumed all too quickly. Actually, Lisa has been for the past several months attending births outside of the law. Earlier this year, she handed in her registration because she no longer wanted to work as a midwife, giving the excuse that she was not happy with moves last year to increase regulation of midwives. However, since relinquishing her registration, she has attended more than twenty births, including the last two deaths. She claims she is only acting as a consultant and advocate, but she is still advertising her midwifery services on the Maternity Coalition website, on the Bellybelly breech birth page for practitioners “who are skilled and experienced with vaginal breech birth” (apparently having a doula deliver a mostly-dead baby counts as experience), on the Essential Baby midwives page, and on Birth Matters.

Yet, in spite of her blatant recklessness and disregard for human life, the homebirth and midwifery community continues to support Lisa Barrett.  We have the 1400 strong  “I Support Lisa Barrett and That’s Final” facebook page, complete with the idiotic slogan “Freedom is in Peril. Defend it with all your Might.” These women are depositing money into her bank account. She also hosted a movie fundraiser night, where 60 people bought tickets at $25 each, and additional people made donations, in an effort to support her legal battle.

This phenomenon is not unique to Lisa Barrett, either. Karen Carr is a midwife who said after the death of a breech infant under her care, “The baby’s position wasn’t the problem, the problem was that the baby’s head became stuck.” She is also a midwife who practiced illegally in both the states of Virginia and Maryland, and who was prosecuted after two deaths and a case of severe brain damage, all within a years time. She recklessly accepted the care of a 43-year-old first time mom with breech positioning and tragedy resulted. But does the homebirth community condemn her recklessness? NO! She is hailed as a hero and the community is raising money for her “defence.” I don’t see anyone raising money for her victims, though.

What about Amy Medwin? Amy presided over the death of an infant in North Carolina, where CPMs are illegal. She is blatantly flouting the judges’ orders and continues to attend births, posting about them on her open facebook page. She too has bunches of acolytes supporting her and paying her legal bills.

And then there’s the great-grandmother of them all, self-taught Gloria LeMay. According to the College of Midwives of British Columbia, LeMay has had myriads of complaints against her, including several deaths; has been given a permanent injunction against practicing midwifery; has even GONE TO PRISON; but continues to flout the law and attend births. Has she been censored by the homebirth community? Of course not! In fact, she is teaching online midwifery courses which have enthusiastic reviews all over the (Oh, look! It’s Lisa Barrett endorsing Gloria LeMay!) internet.

WAKE UP, PEOPLE! If you truly wanted homebirth to be safe,  you’d be outraged at the outrageous behavior some of these so-called midwives exhibit. It’s not a matter of a woman’s “personal choice.” Any woman can have her baby at home with whomever she wants to attend. It’s a matter of who gets to give themselves the authority that comes with the title of midwife and use that title to profit.  And sorry, no matter how much you may protest to the contrary, calling yourself a midwife does indeed impart some semblance of authority. Do those of you who practice safe midwifery really want to be lumped in the same group with these mavericks who take risks with other peoples’ lives? I sure wouldn’t. Any other profession would be banding together to throw the bums out rather than circling the wagons around them. Is this an indication of the real values behind the culture of homebirth? That the advancement of lay midwifery is more important than the safety of women and babies? It is MIND BOGGLING to me that not only is no one speaking out against this egregious behavior, and in fact, they’re all throwing their support behind it.

Why I Chose Hospital Birth

Please give a warm welcome to guest blogger Lauren Baden! Lauren is a SAHM and college student studying to be a microbiologist. She currently lives in northernish CA, while her husband serves in the Air Force. They move a lot, don’t get to  see each other as much as they’d like, and have amazing friends who get them through everything. She has one daughter, Aline, two cats, and a very large dog! She strives to promote safe birth, whether that is at home or in a hospital.

Let me start off by saying I am not against homebirth.  I am all for safe homebirth attended by an experienced medical professional, preferably a CNM.  I cannot in good conscience support unattended births or births attended by direct entry or lay midwives. However, I do believe that there should be state or federal guidelines as to what constitutes a medical professional, meaning there should be standardized schooling to allow more women the ability to birth at home if that is what they desire.

I delivered my daughter on July 16th, 2011 at the National Naval Medical Center in Bethesda, Maryland. I bring this up because I know there could be someone out there who says “Your doctor induced you to make more money!” This is untrue, as my doctor is a military member; therefore she got paid the same amount no matter what kind of birth I had.  Homebirth was never an option for me, because I have multiple medical problems that would have made it extremely dangerous.

The primary concern for my wellbeing, along with my daughter’s, of course, was my heart conditions. I have a mitral valve prolapse with regurgitation. This in itself is not enough to be seriously threatening to my life, but it’s certainly something that needs to be monitored. My symptoms got progressively worse as my pregnancy went on, and since I am fairly asymptomatic from that, it was a cause for concern. Additionally, I have atrial fibrillation, a type of arrhythmia or, put simply, a whacky heart rhythm. This can cause a myriad of problems, and to be perfectly honest, people with AFib really should consider the risks of pregnancy with the condition. On top of all that, I was born with a genetic condition called Neurofibromatosis type 1, and as with many genetic conditions there are varying degrees of severity. My family is very fortunate that, generally speaking, we have had no major problems linked to our NF1. However, one of the major concerns is that we grow benign tumors called neurofibromas on our bodies, and they can often grow on the spinal cord or even in the vaginal canal. One can see why this might cause issues during delivery. The final nail in the coffin, so to speak, was that I developed community acquired MRSA about 2 weeks before Aline’s due date. I had to be on some serious antibiotics, and they are known to cause severe jaundice in neonates. The doctors needed to be able to monitor Aline closely for that and for any signs of infection in her.

It’s tough to say what would have happened had we not had a hospital birth. I don’t know what would have happened if I went into labor naturally, as I was induced at 41 weeks. I’m aware that due dates aren’t an exact science, and normally I would have preferred to avoid an induction, but all of my doctors were strongly recommending scheduling an induction. My heart symptoms had reached an all-time high; I could barely walk up a single flight of stairs without my heart racing. After a 36 hour labor, including an MRI to check for tumors on my spine before placing an epidural, Aline’s heart rate dropping to the mid 50’s, my own heart rate skyrocketing to nearly 200, and my poor husband having his hand nearly broken.. Our precious daughter Aline arrived. Was her birth ideal? No, I didn’t really want to be induced and they had to use forceps as she was stuck behind my pelvic bone. Am I horribly traumatized and do I need lifelong therapy? Absolutely not.

I know that every woman is different, and therefore her choices and her reactions to the outcomes will be completely different. In the end, as long as mom and baby are healthy and happy, that is what matters. One might argue that the trauma of birth will make mom and baby not healthy and happy, but, to me, the argument holds no merit. Childbirth does have inherent risks, there’s no denying that. There is a reason that childbirth was the number one killer of women for countless years. Sanitation, better medical techniques, and better nutrition have all added up to make childbirth less dangerous. Birth is not to be feared, but I’m not sure it should be trusted either. Birth is to be respected, whether it’s at home, in a birth center, in a hospital, or in the middle of the woods with you surrounded by your furry friends. Birth how you want, but please… do it safely.

Off topic WHAT??!?: Proof that Birth-related Issues Do Not Have the Corner on the Sanctimommy Market!

ETA: In a spectacular twist of irony, it turns out that Mom 1 below is Brenda Scarpino-Newport, whose negligence and anti-hospital rhetoric contributed to the death of Mary Beth Chapman.

 

Happened across this little gem on a blog called “Mothers With Cancer.” Allow me to translate:

Mom 1: “I have cancer and I’m commenting on a site called mothers with cancer. I’m hoping to find some solace with other mothers experiencing the same thing. Here I will tell a bit of my story and say something thoughtful and a little little inspiring. I have an amazing attitude and am listening to my doctors and continuing the treatment they and I have decided is best, even in the face of a poor prognosis.”

Mom 2: “You idiot! How could you possibly be listening to your doctors? You know they’re just in it to make money off of you until you die! Which you are no doubt going to do. And soon, if you keep listening to them. Probably within weeks. Too bad you aren’t as insanely awesome as me, who went to doctors but totally ignored what they had to say, and who is curing herself with diet and exercise. You know that makes me superior!! And I’m cancer free!! Not that it actually had anything to do with my self-prescribed treatment, but na, na, na boo boo, you dumb a$$! Oh, wait. Better throw in a little pseudo-inspiring BS lest I look like a complete jerk.”

 

 

 

 

Guest Post: On Bitterness and Babies

Please give a warm welcome to today’s guest blogger, Rachel Welch. Rachel is a former teacher turned SAHM. Her hobbies include composing soundtracks for epic nappy changes, scrubbing cupcakes out of the carpet with baby wipes and searching for lost socks. In the spare 30 seconds left after all that, she might sneak in an episode of Glee or a chapter of Love in the time of Cholera (And yes you read that right it is humanly possible to watch an hour long show in 30 seconds. She has a Tardis). She blogged her way through a long infertility journey, which although painful, did not break her spirit. The only thing which can dampen her mood is when she checks her cupboards and finds them bare of both chocolate and rum. Her lifelong dream was to become a mother of more than one child, now that’s out of the way she’ll settle for a cruise around the world with Gerard Butler. Or just 10 minutes to drink a cup of tea in peace and stare out the window.

“And we can’t use any lubricant, because the embryos don’t like it,” the nurse commented as I waited. I inhaled my breath sharply and gritted my teeth against the pain. Then two excellent embryos were transferred in my first and only IVF cycle. The embryologist looked extremely young-I felt panicky wondering if he was truly qualified for the job.  Regardless, two weeks later I had a positive blood test. “Knocked up and ecstatic,” was my new state of being.

I was one of the lucky ones.  Infertility treatments don’t work for every couple and for some; it takes several treatments to be successful. Despite the fact that 1 in 5 couples will experience some form of infertility (translation: someone you know) there is a perception in many parenting and birthing communities that all infertile women are crazy. Or not just crazy, but also bitter, angry, even consumed by utter jealousy. We’re jealous of women who conceive in a flash and have natural deliveries. Their bodies work but ours didn’t. Our bodies are traitors, theirs are comrades. This perception exists regardless of the fact that many of these women have gone on to become parents. The belief is that they will be this way forever.

As a woman who has been through infertility and out the other side, with many friends whose experiences are similar, I need to correct this assumption. You see, the belief that infertiles are coocoo for cocoa puffs equates to saying a pet owner who can’t stop grieving the loss of their elderly, ill dog is bananas. Personally, I’ve only ever owned one dog and I didn’t grieve that long over his death. Maybe that seems heartless, but I moved out 2 years before he died. So the bond just wasn’t there. My point is; I probably don’t understand the depth of emotion that losing a truly adored, furry companion can bring. And you out there, who points fingers but has never experienced infertility, can’t truly understand that either.

To begin to understand infertility you’d have to first dream up a goal. Any goal, anything your little heart desires. Then imagine how desperately you want it. Let’s say your goal is moving to Paris. Step one in achieving it is getting a job so you can save up. Tomorrow, you’re going out there to apply for jobs. But instead, you get hit by a car and spend months in painful, difficult rehabilitative therapy. Infertility is like that. You know  what you want and you desperately want it, but (due to pure chance) the goal posts keep getting moved further and further away. In my experience, before I fell pregnant successfully, I only endured secondary infertility, 1 ectopic pregnancy, 1 laparoscopy, 3 IUI’s, one IVF fresh cycle and 2 years of trying. A friend’s experience was different; “He showed me a scan and pointed to a dark line, that should have been bright. “You have a blocked fallopian tube.” My husband and I were so relieved. Finally, we had a mechanical reason for our three year long failure to conceive. A reason, a solution and an action plan; “We simply bypass the fallopian tube, place an embryo directly in the uterus, and your prognosis for a successful pregnancy is excellent”. And it was. Less than a year later, our funny, funky, sporty little girl was born.”

No two infertility experiences are identical, but I can safely say that mine was excruciating. I felt torn apart at the very core of me, like my identity had been stripped away. No amount of money, pleading with God or the universe, or developing healthier habits could bring me my baby. I’d go out for retail therapy to lift my spirits and end up seeing babies, pregnant women and families everywhere.

Yes, that was incredibly painful to go through. But I have let it go. I had to let it go because with the benefit of my infertility experience, I know I’d rather be enjoying life with my two beautiful children by my side, than dwelling on the past. I learned what I could from that time in my life and it’s over. There are no second chances, no limitless possibilities and that’s just reality. A different friend who has been through primary infertility agrees; “basically I think the reason I am not bitter is the emotional toll that facing the prospect of not being able to create a child took gave me the gift of perspective. I had to invest so, so much into the most important thing I would ever do, and that made me evaluate life differently. I’ve become so much less willing to invest in things that are trivial, or maybe now I just see things as more trivial than before, but either way I can’t be bitter when I look at my child and realize I was blessed with a miracle. The world is so much more amazing now.”

 

I often hear it said that women prefer seeing a midwife because of the special relationship they develop with this individual, or group of carers. Infertiles develop a similar bond with their OB. These men and women are not heartless or money-hungry. Personally, my health insurer picked up the majority of my OB’s tab, including infertility services. The same beautiful friend quoted above says of her time under a male OB’s care; “My OB is the nicest, gentlest and genuinely caring guy. He has always made sure I understood everything that was happening before I left his office…I was never just rushed through, and if he ever was in a hurry he had his midwife who would walk me through it all. I had panic attacks at one stage, brought on by heart palpitations. I was on the phone to him and burst into tears during an attack, and he pulled strings to get me into a heart specialist (his friend, who was booked out for months) straight away. I had ovarian hyperstimulation during one cycle and ended up in Intensive Care, he was on holidays but visited every single day and called as well to check on me. Then even though it wasn’t his fault he covered my hospital bills, because I had been under his care. He cried with me during my first ultrasound, and again when he delivered Miss E, and got photos with us. He hugged me, and shook my husband’s hand congratulations, visited me again everyday till I went home. He is my hero, and made me feel like he genuinely cared about me.”

 

Couples who experience infertility need to know their provider cares and is invested just as much as those who choose midwives. That level of compassion for their patient means an OB may suggest the way to give birth which is safest for that particular mother and baby pair. They know what their patient really wants-the priceless experience of parenthood. The simple, loving relationship which exists between a parent and a child.

When it was time for me to give birth, I definitely considered the idea of a VBAC. Several of my infertile friends were also set on natural deliveries. Even though medical advancements allowed us to conceive, we didn’t necessarily believe that would be needed on the special day. In my case, I knew I would not be taking any risks. Not because I hate the idea of natural birth. Not because I don’t “trust birth” enough. It was just one simple reason: maturity. Another friend who has experienced primary infertility agrees, “From the moment I stuck the first needle in my belly, I knew I would do anything for my child, and that came to her birth as well. I suffered from unmanageable pregnancy induced hypertension. My blood pressure was such that a trial of labour carried high risk of stroke, for me and my girl. Looking at my options I made a choice and hopped on the surgical table without a backward glance.  My birth plan went out the window, anything for her.”

In my case, I removed my needs from the situation and reviewed the evidence based on my past experience. I’d learned that there are no guarantees in life, none at all. In addition to that, time is incredibly precious. Every agonizing second I’d lost waiting and hoping and wishing but not always really living for that day, was already gone. I was not about to invest another 2 years and 9 months trying to successfully conceive and gestate. That part of my life was done. Here are my thoughts from when I decided on an ERC: I can’t be angry with my body forever. The reality is, I am relieved that, as long as bub arrives safely, TTC is over. I just can’t imagine going through another loss, or 2 more years of this same hell. So I will make my peace with it. 2 children is amazing.”

Those who don’t understand can call me and my friends bitter. But we’re not. You can’t understand this hell and I wouldn’t wish it on you. So please, stop judging and assuming. We’ve moved on.  We are seizing the day. Perhaps it’s time you did.

 

Guest Post: What We Say to Loss Moms

Please welcome today’s guest blogger, Martha Reilly, M.D. Dr. Reilly is an Oregon OB/GYN with whom I have recently been corresponding about the state of homebirth in our great state.

One of the most curious features of homebirth loss stories on the web and elsewhere is the closing remark, most often seen on Mothering.com, that “the doctor said this would have happened in the hospital too.”  Some examples  (all are taken from publicly accessible blogs):

  • A healthy mother labors with very painful contractions at home and, when the baby’s heart rate drops into the eighties, is taken to the hospital where a complete placental abruption is discovered and she undergoes emergency cesarean, but baby is born dead and mom nearly dies from the complications of the abruption
  •  Breech/breech twins are delivered at home,  with a particularly traumatic birth of the second (described in harrowing detail by the father) resulting in a depressed skull fracture. A mom is transported when the fetal heart rate drops and delivered by emergency cesarean, with the infant in for brain surgery and a long NICU stay.
  • A HBA2C with several hours of painful labor and no progress which ends in uterine rupture, the death of the baby, and near-death of the mother.
  • A twin birth with placental abruption before the delivery of the second twin, resulting in the death of that baby.
In all these stories, the narrator takes time out to report that the doctors said that birthing in the hospital would not have prevented the complication. The father of the twins goes one further and insists that he was told by his daughter’s neurosurgeon that a hospital birth would have killed her. This is the moment when, reading these narratives, I mutter, “Yeah, right.”

 

Where does this idea come from, this certainty that what happened at home would have happened anywhere?  Why is it such a fixed idea?  As an obstetrician who has received many homebirth transports, I’ve had way too much time to ponder these questions.

 

Some of the blame lies in the rather fixed and rigid belief systems of homebirth adherents. Birth, they say, is inherently safe, and most birth complications and almost all cesareans are the result of unnecessary intervention, so nothing bad, nothing really bad, can happen at home.  When a birth goes awry, they simply accept the (to me) astonishing concept that it would have happened anywhere.

 

More blame can be placed at the feet of unscrupulous midwives, who have the ear and the trust of the mom, and are busily promoting the idea that the baby’s death was inevitable from the start of the transport all the way to the baby’s gravesite and beyond.    But it’s not just a lack of scruples that leads them to take this stance: many non-medical midwives (such as Certified Professional Midwives) are woefully undertrained and understand the mechanisms leading to intrapartum death poorly.

 

Sometimes this trope results from timing of the narrative. Particularly on Mothering, the posts are often made within days of the baby’s death.  When I read homebirth loss blogs I am particularly interested in the understanding that parents develop over time as they wrestle with their child’s death.  Many parents (and I am thinking in particular of Wren’s and Aquila’s and Mary’s) devastating realizations about the choices they made, but only after months have passed.

 

What about doctors, though?   What information given to parents leads them to report that “the doctor said this would have happened in the hospital?”
To understand what might be going on in the hospital, you have to understand what really happens at an emergency homebirth transport.  We usually get a call that a mother is coming, but very little detail.  Arrival is chaotic. Often the midwife has brought the mother separately from her family and support team. Frequently the records have been “forgotten” or are coming in a second car.  We encourage our local midwives to explain what is happening to us, but in emergencies we are doing this at the same time we are drawing blood, establishing IVs, placing fetal monitors, and performing ultrasound. One of the special challenges in these moments is that homebirth patients many times don’t trust doctors, so we need to establish rapport with them at the same time we are acting as quickly as possible. Since the mother is often exhausted and frightened, it’s a very tense situation.

 

Another challenge is that the midwife’s report of her patient’s labor is often not reliable. There is some outright lying, but most of the problem lies in concepts that are, to put it kindly, different from the model of care we use. A typical report is that “fetal heart tones were strong,”  that is, until they weren’t. Well, thanks, but no thanks. “Strong” has no meaning in the realm of fetal monitoring. Fetal heart tones are either fast or slow, present or absent. The details that I want from fetal monitoring, the ones that REALLY matter (accels, decels, variability) are not discernible without electronic fetal monitoring.  So “strong” is useless information.  Additionally, many midwives don’t recognize, or don’t recognize the seriousness of certain factors (meconium, prolonged rupture of membranes, post-datism), so these might be left out of their story altogether.  Sometimes these factors are present, but explained away, such as the time one of my own patients transferred to a homebirth midwife and then was transported back at 43+ weeks with a stalled labor AND meconium. Her far-past due date was airily brushed away as being an “unsure” due date, even though she’d had a six-week ultrasound.   Some (to us hospital providers) basic information is often missing: some midwives don’t believe in vaginal exams and will allow moms to push based on urge alone, many don’t check temperature or blood pressure regularly.

 

In short, in an emergency transport we generally operate as if the patient has walked in off the street, since what information we have from the midwife may be limited or unhelpful, and do an independent assessment.  It’s important to remember too that precious time has usually been lost by the time the family makes it to the hospital. Most of these mothers arrive by private car, and sometimes they get stuck in traffic.  A laboring woman, in pain and possibly ill, can be difficult to get dressed and into a vehicle.  Even if someone has dialed 911, sometimes the mother’s preferred birthing place is not easily accessible to the EMTs.

 

Remember that our focus at these times is NOT on the homebirth debate. We are simply trying to do the best by our patients. We are not political animals at these moments.  Most of us are not even ideologically opposed to alternative birthing practices (as long as they do not compromise our notions of safety), no matter what popular midwifery blogs might say.

 

Suppose then that the worst has happened, and that a baby dies. What then? I will never forget my first emergency homebirth transport. It followed what I would later learn was the usual pattern: the call came, mom arrived with two midwives and no records, midwife told a story that made no sense (she claimed the baby had been vertex and “heart tones strong,” but at eight centimeters, the baby had leapt out of the pelvis and turned breech, so she brought mom in).  With some difficulty I got the midwife to step out of the way (she had placed herself between me and “her” patient) and addressed the mother directly.  My ultrasound showed a breech baby.  No heart beat. Mom’s cervix was completely dilated.

 

I’ll leave for another narrative how I had to dissuade the midwife from taking charge of the delivery of what turned out to be a perfect baby girl, who was easily delivered as a vaginal breech, and how I finally had to remove her from the room on the mom’s request (she was “normalizing” the baby’s death by coaching the mom to “join in spirit with the many mothers who have lost their babies in birth, and draw strength from them”), and move on to the topic at hand: what did I say to the mother?

 

What would YOU say?  To this day, I am not certain why that baby died.  I don’t have enough information to go on, really. She certainly was dead on arrival at the hospital, and mom certainly had been laboring at home.  I got calls from people I’d never met who told me the midwife had lied about the due date, that the mother was diabetic and untreated, and so forth.  Why might she have died?  Cord entanglement is common enough with breeches, and this might have been the fault.  Or if she was truly post-dates, the placenta may not have been adequate to support the baby in labor. She was not, by any available measure, diabetic.   Who knows exactly why this baby died?  I surely don’t.  Do I believe this birth was preventable?   Yes, that I do believe. If this baby had been monitored properly, and had been in a place where the changes in her heart rate could be responded to appropriately, she would have made it.

 

Here’s the important thing: the question of whether the baby would have died in the hospital never came up between the mom and me. Then or later. This mother has kept in touch with me over the years, and she came to her own conclusion, that her daughter would be alive today if she’d been in the hospital, and possibly if she’d chosen a different midwife.  I agree.

 

Parents, all parents, want desperately to do right by their children. I have NEVER met a parent who wasn’t trying, to the best of their abilities, to provide what their children need. Mothers always blame themselves when something bad happens to their baby.  In the moments of new grief, when the loss is fresh, I would never add to their burden by blaming them or their choices. My actions are not politically oriented;  I would never be answering their questions with an eye to what might wind up on Mothering or Birth Without Fear.

 

So where does “the doctor said this would have happened in the hospital too” come from?  If a patient asked me why her baby died, I would answer to the best of my knowledge, but my answers would be focused on scientific answers: infection, abruption, meconium aspiration, etc. Keep in mind, “home birth” is not a cause of death.  What causes death is failure to intervene soon enough when bad things are happening.  Three factors make this more likely to lead to death at home:  midwives not well-trained enough to recognize a problem in time to intervene, difficulty and delays in transport, and the tendency to view transport as failure.  While they will never show up on the death certificate, these are the things that kill babies.  The truth is, parents have never phrased their question to me as “If I delivered in the hospital, would this have happened?”  at the time of first hospitalization.  These questions come much later, and the parents usually know the answer by then.