Sad story

Thank you for the links, Jean

Jolinda

Donna wrote:

Here's one midwife's page, and her criteria as to whether a breech delivery
should be attempted. I found it interesting. We don't know the woman's
situation, beyond being a breech delivery, so we don't know where she fell
on this scale.

Thanks, Donna

You are right, we don't know.

"Buzzy Bee" wrote in message
...
On Fri, 9 Jul 2004 18:18:41 -0400, "Donna"
wrote:
but then again I might just have mucked up the snipping as usual!

Larrry, Larry... do you have any respectable cites for any of what you
write
above?

www.homebirth.org.uk and www.aims.org.uk both have plenty cites for
the sort of things Larry has talked about.

Megan.

Those are homebirth advocacy websites. Larry states that established
medical practice supports his opinions. I'm curious as to where he is
finding his information about homebirths being "always as safe, and
sometimes safer" than hospital births, and "for a multipara with no
contraindications, a hospital birth at 40 is as risky or riskier than a
homebirth." It certainly isn't the New England Journal of Medicine or
JAMA.

I'm perfectly happy that Larry espouses those *opinions*. Unfortunately,
Larry tends to call his opininons facts. I'd hate for people to be misled.

Donna

Tori M. wrote:

Have you asked your hospital what their "decision to
incision" time is for c-sections?


I now know I should ask that.. I never thought to ask before actualy. I
have an OB appointment on the 21st with the Ob not my midwife I need to make
a list of questions. With Bonnie I had lesss stress then I do with this one
I lived 5 minutes from the hospital on a busy trafic day and it was the
"best" hospital in the city for NICU. This time I am delivering at a
smaller hospital that we only chose because we like the Drs at the office
and they have been good with treating DH out of control blood sugar the few
times we had to go there and leave DH there.

I forget now where I was reading it, but a survey
was done of hospitals and one of the measures they collected
data on was the time it took to get ready for a c-section.
The gold standard is 15 minutes. I think the standard this
study was looking for was 30 minutes. The report I read
was shocked that many hospitals couldn't even be counted on
to make the 30 minutes, even though they *claimed* they
could do so.
The good news is that the *vast* majority of the
time, that wouldn't make a difference in outcome. Even
when one ends up needing a really fast c-section, there
are often warning signs before it becomes that critical
that would give hospital birth attendees the time to
assemble the OR team and homebirth attendees the time
to call ahead and transport.

Best wishes,
Ericka

Nikki wrote:


The thing that holds me back is sort of unreasonable. It is a matter of
what choices you feel like you can live with. If something bad happened at
a home birth I wouldn't deal with that very well at all. I'm talking about
coming to terms with the consequences of my choice. If something happened
at the hospital I think I could blame some one else, or feel like I did all
I could, or bear less responsibility or something. Now that isn't
reasonable but there it is. I know the chances of something awful happening
that would *not* have happened in a hospital setting are very very remote
but it just paralyzes me.

I think that's one of the crucial questions anyone
considering homebirth must answer for themselves: Would
you be better able to live with a bad outcome that resulted
from a lack of doing something (i.e., because you weren't
at a hospital and couldn't intervene fast enough with high
tech medicine)? Or would you be better able to live with
a bad outcome that resulted from a *positive* action on
your part (i.e., because you chose or allowed an intervention
that was unnecessary, or acquired a hospital borne infection
from the choice to be in the hospital). *Personally*,
I can live better with a bad outcome resulting from *not*
doing something than from *doing* something, so homebirth
was a very comfortable choice for me. I'd find it harder
to live with knowing that something bad happened to a
healthy baby in what could have been a healthy birth
than with knowing that something bad happened because
something was wrong with the baby or there was a
serious complication with the birth. But that's just
my personal risk preference. Everyone has different
risk preferences, which is why women ought to have
options.

Best wishes,
Ericka

"Larry McMahan" wrote in message
...

:
: Larrry, Larry... do you have any respectable cites for any of what you
write
: above?

You betch'ch, Donna. I would not make claims like that without!


Lets see... taking out references more than 15 years old (many later studies
provide better data), references from advocacy publications (bias) and
references which don't support your statements (infant leukemia rates
compared to fluorescent light exposure???) leaves us with...


Janssen PA. Holt VL. Myers SJ
Licensed midwife-attended, out-of-hospital births in Washington
state: are they safe?
Birth. 21(3):141-8, 1994 Sep.


"The results of this study indicate that in Washington state the practice of
licensed nonnurse-midwives, whose training meets standards set by
international professional organizations, may be as safe as that of
physicians in hospital and certified nurse-midwives in and out of hospital."

.... may be as safe.... And the only measurement they are looking at is
birthweight.




Declercq ER.
Merrimack College, North Andover, Massachusetts
Where babies are born and who attends their births: findings
from the revised 1989 United States Standard Certificate of Live Birth
Obstetrics & Gynecology. 81(6):997-1004, 1993 Jun.


From the abstract: "CONCLUSION: The positive outcomes achieved in certain
settings indicate a need for further research into the factors that
influence birth outcomes."


Ford C. Iliffe S. Franklin O.
Department of Primary Health Care, Whittington Hospital, London
Outcome of planned home births in an inner city practice
BMJ. 303(6816):1517-9, 1991 Dec 14.

From the abstract: "CONCLUSIONS--Birth at home is practical and safe for a
self selected population of multiparous women, but nulliparous women are
more likely to require transfer to hospital during labour because of delay
in labour. Close cooperation between the general practitioner and both
community midwives and hospital obstetricians is important in minimising the
risks of trial of labour at home."


Outcomes of intended home births in nurse-midwifery practice:
a prospective descriptive study.
Murphy PA, Fullerton J
Obstet Gynecol 1998 Sep;92(3):461-470

From the abstract: "CONCLUSION: Home birth can be accomplished with good
outcomes under the care of qualified practitioners and within a system that
facilitates transfer to hospital care when necessary. Intrapartal mortality
during intended home birth is concentrated in postdates pregnancies with
evidence of meconium passage." This is the first reference that actually
supports your thesis, sortof. But it's a far cry from "safer than hospital
births".



Perinatal loss in planned and unplanned home birth. The Northern Region's
Perinatal Mortality Survey Coordinating Group. BMJ 1996;313:1306-9.

Unable to find the article.


Home versus hospital deliveries: a prospective study on matched pairs.
Ackermann-Liebrich U, Voegli T, Guenther-Witt K, Kunz I, Zullig M,
Schindler C,
et al. BMJ 1996;313:1313-8.

Unable to find the article.


Outcome of planned home and planned hospital births in low risk
pregnancies
in the Netherlands. Wiegers T A, Keirse M J N C, van der Zee J, Berghs G
A H.
BMJ 1996;313:1309-13.

Unable to find the article.


Prospective regional study of planned home birth. Davies J, Hey E, Reid
W,
Young G.
BMJ 1996;313:1302-5.

From the abstract: "CONCLUSIONS: Home birth is valued for its family
setting. General practitioners' support is sought and influential but
uncommon, possibly because of a lack of understanding of the
responsibilities of the midwife and general practitioner." This article
is about how women *felt* about their home birth experience. Again, it's
not supportive of safety, and doesn't necessarily support your statements.


Besides, you left out any reference to articles which document a higher risk
of homebirths. There are quite a few.

Safety of home delivery compared with hospital delivery in The Eastern
Region Health Authority in Ireland in the years 1999-2002.

McKenna P, Matthews T.

Department of Obstetrics, Rotunda Hospital, Dublin.

A comparison was made of deaths from intrapartum hypoxia of normally formed
babies 2.5 kg born at home (N = 346) and those born in hospitals (N =
61,215). If the intended place of birth is home the chance of dying due to
intrapartum hypoxia is 1:70 (5 in 346). If the intended place of birth is
hospital the chance of dying is 1:3600 (17 in 61,215). Although the sample
size of home births is smaller, the difference is significant ( 0.01 level
of significance). In view of the small number of home births, the need for
ongoing monitoring of home births over a longer period is essential.

The thing that would concern me about this reference's validity is the
difference in sample size, however.


Outcomes of planned home births in Washington State: 1989-1996.

Pang JW, Heffelfinger JD, Huang GJ, Benedetti TJ, Weiss NS.

Department of Epidemiology, University of Washington School of Public Health
and Community Medicine, Seattle, Washington 98195, USA.


OBJECTIVE: To determine whether there was a difference between planned home
births and planned hospital births in Washington State with regard to
certain adverse infant outcomes (neonatal death, low Apgar score, need for
ventilator support) and maternal outcomes (prolonged labor, postpartum
bleeding). METHODS: We examined birth registry information from Washington
State during 1989-1996 on uncomplicated singleton pregnancies of at least 34
weeks' gestation that either were delivered at home by a health professional
(N = 5854) or were transferred to medical facilities after attempted
delivery at home (N = 279). These intended home births were compared with
births of singletons planned to be born in hospitals (N = 10,593) during the
same years. RESULTS: Infants of planned home deliveries were at increased
risk of neonatal death (adjusted relative risk [RR] 1.99, 95% confidence
interval [CI] 1.06, 3.73), and Apgar score no higher than 3 at 5 minutes (RR
2.31, 95% CI 1.29, 4.16). These same relationships remained when the
analysis was restricted to pregnancies of at least 37 weeks' gestation.
Among nulliparous women only, these deliveries also were associated with an
increased risk of prolonged labor (RR 1.73, 95% CI 1.28, 2.34) and
postpartum bleeding (RR 2.76, 95% CI 1.74, 4.36). CONCLUSION: This study
suggests that planned home births in Washington State during 1989-1996 had
greater infant and maternal risks than did hospital births.

PMID: 12151146 [PubMed - indexed for MEDLINE]

Outcomes of planned home births versus planned hospital births after
regulation of midwifery in British Columbia.

Janssen PA, Lee SK, Ryan EM, Etches DJ, Farquharson DF, Peacock D, Klein MC.

From the abstract: "There was no increased maternal or neonatal risk
associated with planned home birth under the care of a regulated midwife.
The rates of some adverse outcomes were too low for us to draw statistical
comparisons, and ongoing evaluation of home birth is warranted."

You left this one off you list, I think. It supports your statement that
home births can be as safe. But again, "No increased risk" and "Safer than
a hospital birth" are not the same things.


I could go on, but I don't know how interesting this is to anyone else. Pub
Med has a bunch of current articles indicating that there are, indeed,
increased risks to having a homebirth. This doesn't even remotely imply
that any particular homebirth is necessarily riskier, indeed, the risk
factors were lower than I personally would have expected, but they are
there.

Opinion is one thing, and a wonderful thing it is. But if you present
something as documented fact, it needs to be backed up, or your credibility
suffers.

Donna

RLK wrote:

I felt just that when I was in the hospital to deliver my baby. I had gone
in to be induced 2 weeks early.... I don't know why I went for induction, I
hadn't planned on it originally, but near the end I just felt the time had
to be *now*. Call it a premonition. Only when I arrived at the hospital and
all hooked up and pitocin underway, did the staff notice my baby's heartbeat
was irratically going from high to low to be normal. Nobody said a word to
me, I almost didn't want to know anything except to breath, push, breath,
push.

It turned out my baby had twisted through the umbilical cord and had formed
a "textbook" knot. He was already 2 weeks from full term and was already
pressing on the cord somehow during the contractions so he wasn't getting
enough oxygen/blood. I delivered him within 20 minutes of active labor and
sucking oxygen into my body like this was the end of the world. The doctor
cut the cord and all this blood from the knot just blew out all over him. I
shudder to think if I had waited the full two weeks my baby might have been
delivered stillborn, or worse if I had him at home and took hours instead of
minutes to get my baby out in time.... I don't think I would have ever
recovered if the worse had happened.

I certainly understand how you feel. On the other
hand, what are you advocating here? That every woman be
induced two weeks early for no indication because there
might be an undetected knot in the cord? (Because you
said bad things could have happened had you not been
induced then.) And do you think that they wouldn't have
noticed the erratic heartbeat right away if you'd been
at home, or that they wouldn't have had oxygen? And if
labor had started naturally rather than via induction, the
contractions would likely have started more mildly,
likely giving more time for a transport before things
got dangerous. Why do you think it would have taken
hours to get your baby out at home? Do you think they
wouldn't have transported for such erratic heart tones?
It would be a very rare (and incompetent) midwife who
wouldn't have transported in that case.
True knots *are* dangerous--and you're right
that they can cause a late term stillbirth out of the
blue. However, that happens with planned hospital
births just as easily as with planned homebirths.
In fact, just because there are so few homebirths,
the vast majority of stillbirths caused by true knots
*do* happen to people planning hospital births.
I'm very, very glad that didn't happen to you, but
this really isn't much of a homebirth/hospital birth
issue unless you're in a situation with inadequate
transport plans.

Best wishes,
Ericka

"Donna" wrote

www.homebirth.org.uk and www.aims.org.uk both have plenty cites for
the sort of things Larry has talked about.

Megan.

Those are homebirth advocacy websites.

AIMS is a midwifery advocacy site, not just homebirth. And they base their
reports on published articles in peer reviewed journals. For example, the
first link I posted last night cites a reference from the Lancet, the
British equivalent of the NEJM. They also cite the British Medical Journal
and British Journal of Midwifery elsewhere on the website, among others.
Both of thoses publications would be considered eminently reputable. Or do
you only want American cites?

Jean

Vicky Bilaniuk wrote:

ChocolateTruffles wrote:

Vicky Bilaniuk wrote:

The whole thing is very sad. I wish we had more details. Would be
something to learn from.



Apparently the "fake" midwife is being charged in the death of the
baby. Here are 2 stories I found:

http://vancouver.cbc.ca/regional/ser...idwife20040706
or http://tinyurl.com/2zt4a

http://www.canada.com/victoria/times...3-623133802b6d

or http://tinyurl.com/22fgs


So at least one lesson is to be sure of credentials. Pretty scary.

Well, credentials don't always tell the whole story.
There are many highly experienced, very competent lay midwives
who, for various reasons, do not have credentials. In the
US, direct entry midwives are legal. They were in the state
where I had my first two births, and I chose direct entry
midwives because they had the experience and provided the
type of care I was looking for. Neither of them had chosen
to have one or both of the two credentials available to
them. We discussed why they didn't (long story) and what
experience and education they *did* have, and I was very
pleased with it despite the lack of an external credential.
In areas where direct entry midwifery is illegal
or where it is regulated to require certain credentials,
the situation is more difficult. In that case, midwives
operating without the required credentials are deliberately
flouting the law. Some experienced and very good midwives
do it to offer women options the law does not afford. For
instance, direct entry midwivery is illegal in Virginia.
There are DEMs practicing illegallly here who are very
good midwives and choose to risk legal sanctions in order
to provide women options (especially in areas where
no CNMs do homebirths, which is most of VA). On the
other hand, some are no doubt practicing without credentials
because they can't *get* the credentials.
Finally, there are midwives who *have* credentials
but are still bad midwives ;-)
So, ultimately, credentials are only one part
of the picture. They give you information, but you need
more information to be able to interpret it successfully ;-)

Best wishes,
Ericka

"Ericka Kammerer" wrote in message
news:zsCdnf1rzN3edHLdRVn-
I certainly understand how you feel. On the other
hand, what are you advocating here?

I'm not advocating anything here, Ericka.... I just wanted to share my
story....