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    Jul 26

    "A Home Birth Would Have Killed Me/My Baby"

    Archived User
    I know that women who make this comment often have a poor understanding of the training and qualifications of Certified Professional Midwives and Certified Nurse Midwives, (those who attend home births, at least), including the ability to recognize high-risk situations and refer out when necessary.  They are also unfamiliar with the research that confirms well-attended home birth a safe option for low-risk pregnancies. 

    It doesn't help that their fear-mongering OB's are confirming these misconceptions.  The ACOG's anti-home birth statement wags its finger at women with a reminder that "complications can arise with little or no warning even among women with low-risk pregnancies."  

    In line with this statement, these women usually mention events that "came on suddenly."  I know that CPMs carry appropriate equipment and are trained in neonatal resuscitation.  I also know that with the liberal use of pitocin in hospitals, fetal distress is all too often iatrogenic.  But I'm curious about other complications. 

    I most often hear about pre-eclampsia and placental complications (e.g. placenta accreta).  How are Certified Professional Midwives trained to detect and respond to these complications?  And are there any similarly risky complications that I'm not considering? 
    Archived User

    I am the mother of four and a birth doula. I gave birth to my two youngest children at home attended by an excellent CPM. I find what you have written to be thought provoking mostly because as an aspiring midwife, I think about the issues surrounding the education of midwives endlessly. It was a struggle to decide which path to take. On the one hand, CPM training through a MEAC accreditted school would be the most APPEALING to me as a woman who wishes to attend low risk mother's at home, but complications in low risk women can and do happen and often without much warning. Knowing this fact and realizing that losing a baby or mother as a result of my lack of knowledge or experience is just not an option. This is why I have decided to earn my Bachelor's degree in nursing and then go through a CNM graduate program. I have made this decision, not because I feel ALL CPM's are undereducated, but because I believe a minority of them do not appreciate the weight of attending births at home and don't have sufficient experience. There are many opportunities for new CPM's to get EXPERIENCE with a myriad of complications, but it entails working at a birth center in Texas or going out the country to attend foreign women. Usually a midwife who chooses to do this sees complications and issues she would never see  working with a homebirth preceptor in the US, not once but many times. It helps her to learn not only how to manage these kinds of complications, but how to recognize them in time. This  type of enrichment in the current CPM training is, in my opinion, essential to building a good homebirth midwife, but it is not a requirement. Working in a hospital (to gain experience) will be very hard for me, but I will see complications and high risk cases and that is what I need in order to feel comfortable and confident caring for low risk moms and babies at home.  We all need to work together to keep homebirth safe and legal. Pretending that there aren't tragic, preventable accidents that happen at homebirths caused by a lack of knowledege is counter productive to this cause. It does happen and when it does, it gives midwifery a bad name. Here is a birth story from MDC illustrating what I'm talking about.

    I realize that many atrocities also happen to women when attended by OB's in the hospital. However, I'm not trying to become the best OB, I'm trying to become the best MIDWIFE I can be. I want to keep homebirth a viable, safe option for low risk families and in order to do that I think the next generation of midwives need to make demands of themselves to go above and beyond with our education and experience.

    Archived User

    As a midwife of nearly 30 years and doing homebirths for nearly 4 years I will put in my perspective.

    Safety is a balance between riskmanagement and faith in the ability of the woman's body to birth her baby. I would not attend a woman at home if she has not self educated herself on birth, including things that can go wrong. Also she (and her support people) need to believe she can do it and that with the right precautions, it is safe.

    I would need to know any risk factors in her health and past obstetric and gyanecologic history.

    So, I go the birth expecting things to go right but watching for problems and carrying equipment to deal with it. I also have the skills to do emergency care while help comes to transport to hospital if things go wrong.

    My main job is in a rural hospital in Australia, in a low risk birthing unit. We are an hour's drive from the tertiary hospital and don't have obstetricians in town. The outcomes for the unit are really good because of the risk management strategies.

    Two of the biggest influences are the low risk women only that we book, and the fact that we don't do any high risk causing proceedures such as induction, epidural, membrane rupture or continuous fetal monitoring. All of these things cause problems, don't do them, minimise problems. Works for us. We also look ahead all of the time and if things seem to be going pear shaped we transfer early rather than late. We might transfer and she has a normal birth at the referral hospital but better that than something go wrong in a low risk unit. You will probably find homebirth midwives do the same.

    One needs to be careful going too high tech with the training first, one might lose faith in a woman's inherant ability to birth. It then takes a lot of retraining to get it back. Without the faith, one looks for machines that go ping! to try to make things safe.

    Archived User

    Having been an OB nurse for 10 years and now a home birth midwife for 10 years I can't tell you the number of times I heard in the hospital, "Thank God, Dr.____ was here!  He saved my baby's life!"  Little did this woman know, Dr. ____ is also the one that caused the fetal distress that caused the emergency c-section that almost cost her her baby's life!  I had to bite my tongue so often, I'm sure it's a little bit shorter than most.  Since I help almost exclusively Mennonite women, they have a different take on life.  They tend to be very wary of medicine and doctors.  A woman asked me to care for her during her second pregnancy, her first ended in an emergency c-section for fetal distress.  She told me the birth story as she remembered it and said she thought none of it would've happened if she hadn't been in the hospital.  I got her old records and I told her, "You're exactly right."  She had high blood pressure of pregnancy (NOT toxemia or preeclampsia) and the doctor induced her at 38 weeks.  After 12 hours on pitocin, and at 1 cm dilation, the doctor broke her water and attempted to place a scalp electrode on the baby (all this in a circle about the size of the eraser on the end of a pencil!)  Big surprise, the baby's heart rate took a dive and stat c-section!  Of course healthy, crying baby.  Then almost a week in the hospital trying to recover from a wound infection and then finally signing out AMA (against medical advice).  The next day her fever finally broke and she started to recover at home.  She really had PTSD from this experience.  With her 4th pregnancy we found out it was a twin gestation.  I tried to talk her into going to the hospital, because a twin gestation with a scarred uterus was too high risk for homebirth.  She talked me into attending her at home because she and her husband were so against hospitals.  All went well, very well.  2 little girls born 15 minutes apart, head down and both weighing 6 pounds. 

    Henci Goer

    I am glad everything went well for her and honor you for being willing to attend her. Words cannot express my anger at an obstetric system that by mistreating and traumatizing her,  put her and you into this situation.  

    -- Henci

    All Times America/New_York

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