I’ve spent part of the night reading about babies who didn’t have to die. And I don’t want their stories to be yours. If you’re pregnant or planning, and considering giving birth outside of a hospital, please stop right now and read Grant’s story. His mother Rachel had to tell it. He didn’t live. He didn’t have to die.
Let me remind you that when I first arrived at the birth center for the second time that evening I was offered a transfer for not being able to handle my labor. Why, now with my baby dying were they not offering us a transfer? Why were they trying to make me push when I wasn’t dilated?
I was moved from the birthing stool to the bed… still not 100% dilated. I was told that I needed to get this baby out now. I’m still trying to push. I’ve never pushed so hard in my life. The pain is so bad that my vision is becoming blurry. I was given oxygen. When I look back at this scene I still wonder why no one has called for help. The baby has been in trouble and I’m having a hard time… why?
My husband and I were so focused on pushing this baby out as fast as possible and so focused on what we were doing that we couldn’t stop and tell her to call 911. We weren’t sane. We were relying on all of those midwives to do that for us if need be. We were counting on them to make the decisions that would need to be made when necessary. We were still all on our own as our baby was losing his struggle to breathe.
Read her whole story. Read about her having to leave the body of her perfect baby boy in the arms of crying nurses. If your heart didn’t shatter into atoms, you had no heart to begin with.
People, I have read far too many stories about dead babies. There are stories all over that site, and all over Dr. Amy’s blog, and in so many places I cannot remember them all. So many women who thought they were doing the right thing for themselves and their babies. So many women who didn’t know that when labor and delivery go catastrophically wrong, they can do so without warning, and without time to reach a hospital. So many women who didn’t realize that their supposedly-professional midwife would refuse to transfer even when she knew the baby was dying. So many women who knew something was wrong, but were told by their midwives it was fine, and then it wasn’t. So many women whose midwives should have recognized a problem, and didn’t.
Please read Grant’s story, and Shridam’s story, and Magnus’s story, and Angela’s story. Please reconsider what you’ve been told about the glories of a natural birth in a non-hospital setting. Please realize that you will not fail as a mother and woman if you choose the hospital instead. Please learn the difference between Certified Professional Midwives, Professional Nurse Midwives, and Ob/Gyns. Please be skeptical, and ask hard questions. Please make the safest choice possible.
I don’t want the stories of those dead babies to become yours.
Thank you to the mothers who had the courage and compassion to tell their babies’ stories. I’m so sorry you had to. No one should ever have to bear that pain.
Amateurs can :help with anything … they can coach in sports, they can tutor students, they can help you navigate the government bureaucracy. But any idiot who thinks that the first thing to say to a pregnant woman who is in the least distress isn’t ‘Get thee to a hospital’ ought to be prosecuted!
Child birth is a completely natural phenomenon. So is dying in childbirth.
Things go wrong too fast. Even in the hospital emergencies can cause death, but out there, without the right equipment and specialists? Dead babies. Dead women. Sure it isn’t likely if you are young and healthy, but it CAN happen. Be in a hospital.
When my daughter said she was having a midwife for her second child, I was quite anxious. During delivery, something can go wrong quickly. My idea of having a midwife was having a home birth.
However, things are different now here. (Ontario, Canada) A midwife is available during pregnancy to assist in many ways. When labour begins, the midwife would go the hospital with the woman, stay with her, and coach her through the various stages and call for help if anything seemed not right. The nurses and doctors can not with with an in labour woman constantly.
After the birth, the midwife was available by phone 24 hours a day for the first while and would come to the house a few times to answer any questions.
There is an arrangement with the qualified midwives and many hospitals. In many hospitals, the midwives are welcome as part of the pregnancy process. The midwives step aside if there are any complications or concerns and let the doctor take over. The doctor usually does the actual delivery.
As it turns out, there were concerns about the baby’s heart rate being too fast at some times during pregnancy. The midwife readily said that was out of her area of expertise and turned my daughter’s care over to the physicians at the high risk facility with which she (the midwife) was affiliated. The midwife continued to be available for questions and labour. In the end, my daughter had an emergency C-section, so her midwife was not there.
This was a whole different view of midwifery than I had from before. This way gives a pregnant woman a lot more personal care while still having all the regular doctor appointments, physician care, and hospital delivery. It seems really desirable to have such a midwife. At least, that is how the midwives work in this city. It actually is a good system.
A home birth can be such a dangerous and disastrous choice. Some people feel it is all lovey and cozy and natural to give birth at home. They need to consider how many babies in the past have been lost during that process.
Birthing rooms in our hospitals are private and quite comfortable and there is no moving to a delivery room. Most importantly, trained physicians are readily available if an emergency arises.
I am not sure why anyone would want to take a chance with home delivery.
I’m confused but that’s maybe because the NHS offers homebirths with their own midwives and a kind of automatic pre-booking with a hospital in case of need of transfer. In the Netherlands, I believe they use homebirth as the standard, presumably with their health service’s midwives, and excluding any woman who seems likely to have complications. It seems much more professionalized.
Incidentally, these stories are very anecdotal and comparable horror stories for hospital births are easy to find. You need statistics to sort out what’s really happening and I believe they say that planned homebirths with a professional midwife are as safe as hospital births. Unfortunately, the statistics sometimes include all out-of-hospital births such as the three-month early delivery of my nephew in the back of an ambulance (he’s fine now).
One of the things people can’t often quote is the most common reasons for death in childhood. These are/were too much loss of blood after passing the placenta, especially if there is some left behind (e.g. after everything seems to be over, also easy to treat these days and less likely to be a problem in healthy women), infection in the days following childbirth (treatable by antibiotics, long may they last), botched abortions (which is considered death in childbirth by the WHO), and lastly, all other complications.
Of these, only the ‘other complications’ can lead to death during labor which is what we tend to think of as ‘death in childbirth’. Risk factors for a large majority of them are easily identifiable pre-natally (provided the mother has those check-ups). Unfortunately, the specter of death in childbirth still hangs over women and causes fear of the labor process itself, even though this isn’t where the main dangers ever lay.
This was also true for infants, incidentally. Worldwide, statistics tend to include death, often by infection, for up to a few days following birth as death at birth. Infection is the lead cause why dying at birth or in childbirth once seemed natural.
Pen, I think part of the problem is that in the US, midwifery has largely been marginalized by the medical community. Rather than working together as they do in The Netherlands to determine who are low risk, etc. the American medical situation is all kinds of fucked up. First of all, prenatal care: insurance in the US sucks. Women who are at risk or addicts, etc. may forgo prenatal care for fear of being arrested. Next, many people do not understand the distinctions in midwife credentials. A nurse midwife with transfer privileges an low risk clientele is probably a good choice for some mothers. Hospital births can also be very expensive, where some midwives have a sort of one time fee of a few thousand dollars.
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These stories are indeed terrible, but I think Dana’s main point of self education, research and being informed would do every expecting parent well. I think part of the blame (a large part) lies at the feet of the obstetric community, who for many years used unnecessary and medically unnecessary procedures in childbirth. The lithotomy position is well known to be far less than ideal, and yet that is the norm in most US hospitals. Treating every birth as high risk is not always the best case and sometime causes more harm than good. I’ve got plenty of anecdotes from women who had unnecessary epesiotomies after explicity asking not to have them done. I’ve seen moms coerced into medication they did not want. I’ve seen doctors callously deny a mother a perfectly reasonable request. By saying all midwifery is all bad they have done women a great disservice. I’d like to see nurse-midwives and OBs working together in tandem to make sure that women and babies get the best, medically indicated and accurate care possible. The US has the highest maternal mortality rate in the industrialized world, and that isn’t from homebirthing. It is mostly accounted for from lack of prenatal care and other issues. That is a problem. The WHO recommends a C-section rate of less than 15% for an industrialized country and the US is nearing 40%. That too is a problem.
You seem to strongly imply that all births should be in a hospital. Why? I too prefer statistics to anecdotes when trying to make an informed choice.
Are unqualified people really allowed to call themselves midwives in your country? That appears to be the salient issue.
I’m talking to my girlfriend about this article. She is a returning Student Midwife in the UK and, to be fair, she tells me that in the first story alone there are decisions made that would not be recommended here.
Make me feel very lucky and grateful for the NHS – prenatal checkups and planning with a qualified professional midwife, a routine of postnatal checks, and the ability to choose a “domino” (I have no idea why they call it that) which is pretty much as mary described for Canada: your “own” midwife with you in hospital in a room for one, with specialist staff available right next door on the ward (and epidurals etc. available as wanted). All free at the point of access of course.
Purely coincidentally, the local hospital is so near I was able to phone the midwife to tell her I was heading in and ask her to meet me there, and walk.
I have a lot of online friends in the US and am often shocked and horrified by what people have to face. Bad enough to be ill, let alone ill and facing bankruptcy if you don’t have the right insurance. I am so sorry for the cruelties of a health system that effectively pits midwives and doctors against each other, and forces people to go without healthcare because they can’t afford it.
What terrifies me is the UK politicians and other financial interests who are actively trying to dismember the NHS and emulate the US system – surely the worst, most expensive and inefficient in the industrialised world.
My wife gave birth with a midwife, but that doesn’t mean it was a home birth. The midwife was a Certified Nurse Midwife, a fully qualified graduate of nursing school, and the birth took place in a hospital. My and my wife’s experience was little different from what it would have been had we used an OB/Gyn. We only chose a midwife because we didn’t want a C-section unless it was really necessary, and OB/Gyns in our part of the country order them very readily. There is no way we would attempt childbirth away from a hospital.
This sort of midwifery (the kind you mention) is the kind I whole-heartedly support. There’s a similar system here, with one actual doctor supervising the several women in labour at that point, but with most of the grunt work (besides the actual labour) on the midwives and nurses, who are fully trained medical professionals, just not doctors. In case of an emergency, the doctor is close by and unexpected situations can be handled as necessary (though Latvia still has a dismal maternal death rate, for a LOT of other reasons…).
I think it’s nice to have a medical professional who also forms that personal bond with someone before such a strenuous and often traumatic experience – it’s really difficult to go into labour, knowing everything about what could go wrong, and be faced with a whole team of complete strangers (who can be super-nice and awesome, and who can be… a lot less so).
Anyway, home delivery, I think everyone should be able to make that choice – but they should be fully informed and even overinformed and they should sign a bunch of papers about refusing a hospital birth beforehand, esp. in potentially high-risk pregnancies (though… yes, this can happen suddenly and unexpectedly half-way through, too!). My only fear here is that it could go the way of the vaccination-by-choice-and-information. So I’m far more against home delivery, esp. personally, but… Dunno. For some people, it’s just that much more comfortable knowing the option is at least available.
I wonder if that percentage can be reduced in the US by calling all C-sections-by-choice (that is, not including those that are medical emergencies) as ‘abortions’? (After all, you’re ending the pregnancy at a previously self-designated date, not via natural!AMAZING!childbirth.)
Amy Tuteur actually talks a bit about home birth in the netherlands.
http://www.skepticalob.com/2013/04/dutch-midwives-struggle-to-avoid-accountability-for-high-perinatal-death-rate.html
From the link above:
In Denmark deliveries are mostly done by midwives. Midwifery is a 5 year university education, with a proscriber period of on the job training.
Most births are at hospitals with a surgeon on call (a gynaecologist). Prenatal care is done in unison between your GP and the hospital you will deliver in. Some people still choose home births, but that would be with a Midwife present, that is a trained midwife.
Ad to the larger pictures. when comparing home births with hospital births you have to take into account that most births that was known beforehand to be potentially dangerous will be scheduled at a hospital. Emergencies during pregnancies will also go to a hospital, so when comparing statistics, one should not look at all hospital births compared to all home births, but all hospital births with no previous known issues compared to all home births. And if you do that the hospitals births come out on top with regards to homebirths.
The Science based medicine blog has looked as this subject for instance Here, here.