The tragic case of a home birth

As a ‘home birth’ CNM of 20 years of home birth experience preceded by 10 years of perinatal and intensive care in hospital experience I would agree that maybe it may have been prevented. However, I would also agree that there is no in-hospital guarantee that this tragic outcome would have been any different. I have witnessed a case of an in hospital prolapsed cord where 45 minutes of delay occured while the nurse waited for the M.D.’s and surgical team to arrive to the hospital and set up. It was a case of a multip with the fetus at 3 plus station, second stage of labor with a rapid descent of the baby, and she was told by her labor nurse not to push until the doctor could arrive. The baby suffered irreversible brain damage. Had she continued to push the baby would have been born without brain damage no doubt. This is just one story of an iatrogenic tragic case. Research also supports the conclusion that artificial rupture of the membranes is also associated with prolapse cord. AROM is a common intervention that almost all the patients in labor and delivery experience.
I saw many ‘preventable’ situations result in disaster- IN THE HOSPITAL. Of course, if one follows the logic of prevention of all possible ‘bad outcomes’ to the baby, then planned cesarean would be the ‘safest’ way to deliver, though even that has many risks to the baby from scalp cuts to respiratory problems etc.
Midwives err when they don’t screen their clients properly. The missed gestational diabetic with polyhydramnios (excessive amniotic fluid) that may ‘wash’ down an umbilical cord with an ‘unengaged’ baby. Breech babies, particularly footling breech babies or twins are at higher risk of prolapse. Regrettably, some midwives will assist women to attempt home delivery in these ‘higher’ risk women. All babies need ‘monitoring’ in labor and auscultation of the baby’s heart rate with a doppler at routine frequent intervals is equivalent to an external monitor in picking up the heart rate pattern that would reasure one of the babies status. The problem is not ‘home birth’ but appropriate screening, correct prompt interventions when needed such as oxygen and IV fluids, and a system that supports a rapid transfer to a hospital should what would be the infrequent need to transfer to a hospital occur. In my practice I have transfered 3 cases of fetal ‘stress’ (not yet in distress)in a timely un rushed by car transfer, and 4 cases of post partum bleeding stabalized with pitocin, methergine, iv fluids prior to transfer, and these were out of over 400 planned home births. Most of the transfers, are for the ‘failure to progress’situation where we have all the time in the world to transfer. Home birth is and can be a very safe option if basic protocols of care and transfer to hospital performed appropriately.
As there are incompetent doctors so too nurses and midwives.