Tuesday, September 21, 2010

What if something goes wrong at a homebirth?

What happens if something goes wrong at a home birth?
(revised 9-22-10)

This is what most people fear when it comes down to it (the issue of no pain killers aside). Does being at a hospital mean that if something emergent happened with you or the baby it would all end ok???

A mother and/or baby can die no matter where the baby is born (home, car, in the woods, labor and delivery room, c-sect table, etc). None of us has any guarantee. There are however more interventions in a hospital labor and delivery that make emergent situations a bit more likely to happen. When synthetic oxytocins (Pitocin and Syntocinon) and synthetic prostaglandins (Prepidil and Cervidil) are used it is not natural. The drugs are trying to do what the body wants to do on its own. In some cases these medicines may be necessary, but absolutely not in the 20-80% (depending on the hospital) of births they are currently being used in. And for the record, the strongest natural prostaglandin is found in semen. This prostaglandin can start labor, help contractions get stronger (only advised when your water bag is still in tact) and it has NEVER ruptured a uterus as the synthetic versions can. So, get busy! :)

 

Epidurals have their own slew of problems (from http://www.nt.net/lerouxma/complications.htm, more risks also listed in Pregnant in America), and it is estimated that roughly 80% of women birthing in hospitals in America have an epidural:
Seizures
Toxicity (CNS & CVS)
Fetal Bradycardia
Fetal Acidosis
Total Spinal
Paralysis
Cardiac Arrest
Back problems
Bacterial Meningitis
Epidural Abscess
Lumbosacral Nerve Injury
Femoral Nerve Injury
Peroneal Nerve Damage
Epidural Nerve Puncture
Cardiac Arrhythmia
Maternal Hypertension
Inadvertent Dural Puncture
Postdural Puncture Headache
Urinary Retention
Nausea and Vomiting
Drug Overdose
Hypotension
Respiratory Depression
Hypoxia
And get this (from http://en.wikipedia.org/wiki/Epidural)- Delayed onset of breastfeeding and shorter duration of breastfeeding: In a study looking at breastfeeding 2 days after epidural anesthesia, epidural analgesia in combination with oxytocin infusion caused women to have significantly lower oxytocin and prolactin levels in response to the baby breastfeeding on day 2 postpartum, which means less milk is produced. Most women with epidurals end up with pitocin augmentation because the epidural slows down the labor.

Problems to a baby from Epidural use by the mother:
Lowered neurobehavioral scores on newborn
Decrease in muscle tone and strength
Respiratory depression in baby
Fetal Malpositioning
Fetal heart rate variability
Increase need for forceps, vacuum and cesarean deliveries and episiotomies (OMG!!!)

In cases where an emergency cesarean is needed, thank goodness we have epidurals available! But the huge majority of women getting one just makes me think that maybe we don't all actually need them. Just because it's available and considered 'relatively safe' doesn't necessarily mean it's the best choice for us and our child. There is also the fact that about 20% of women that do receive an epidural don't experience full or even any pain relief (like me). There's no way to know if you'll be in that 20% until it happens.
Epidurals are shown to slow down labors often bringing with them a 'need' for synthetic drugs to stimulate labor to speed up. I wish that all the risks associated with epidurals were made more clear to mothers and fathers and there was more education about it all in general. "Epidural analgesia is associated with longer labor. Some researchers claim that it is correlated with an increased chance of operational intervention" (and perhaps the climbing c-sect rate in the US).- http://en.wikipedia.org/wiki/Epidural#Prolonged_labour_and_risk_of_instrumental_delivery .

Why are so many women given the Scarlet Letter of Failure To Progress?
Many US hospitals allow a laboring mom 12-24 hours of labor before she is considered FTP (failure to progress). Some mothers have a first baby in an astonishing 2 hours start to finish- this is not reality for most though! Many women do take 24 hours or more, especially with a first child and experiencing prolonged labor from an epidural. Can you imagine trying to take a poo in a bathroom with strangers coming in and out, checking your 'progress', telling you when to push and when to wait, and then saying you are not able to poo on your own if you haven't finished in 5 minutes? Uh, no! Some people can poo in 20 seconds flat, some people need 45 minutes and total quiet! I know that sounds like a crazy example, but having a baby is a natural bodily function for a women, just like going to the bathroom. Obviously it is not seen as natural by many, but it truly is. When given space, freedom, privacy, and the ability to labor how she needs to- a woman is free to let her body do what it needs to do. Being able to relax in labor is SO important (the same reason many of us have bathroom reading materials). Being able to move around and go pee and have food and liquids if desired is also important.

So, can things go wrong at a home birth? Yes. Can things go wrong at a hospital birth? Yes. Do babies and mothers die in both places? Yes.
When people hear I'm having a homebirth it's usually met with something like this,"wow, no painkillers, huh? That's hardcore. But what if something happens? Things go wrong all the time and then you won't be at the hospital. That's so dangerous.Your midwife can't do a c-sect, etc, etc". And then there's the awesome (being sarcastic) back-handed compliments, "wow, you're amazing and brave to do a homebirth. I would never do one because things can go wrong and I wouldn't want something to happen to the baby." AS IF I DON'T CARE ABOUT MY BABY AND SOMETHING GOING WRONG? AS IF I HAVEN'T SPENT MORE HOURS THAN I CAN COUNT READING AND RESEARCHING EVERYTHING? Having a baby at home is not irresponsible. In the 32 countries with less babies and mothers dying than in America (see previous blog for links), a homebirth or midwife attended birth is actually considered normal!
Often the numbers favor homebirths in terms of infant and mother mortality. The hospital is not the 'be all end all' solution to a problem labor. I honestly believe that situations where a medical emergency arises are more likely to happen in a hospital situation. In the small percent of women (1-10% usually, depending on the midwife) that need to be transferred to a hospital it is wonderful that we have medical interventions available. The other 90-99% of women does not need to be treated like they are sick or problematic just because they are having a baby!

Are there any extra risks to a home birth? (from http://www.nctpregnancyandbabycare.com/info-centre/information/view-32)


Research has found that home birth is as safe as hospital birth for healthy women having a straightforward pregnancy. (This has been confirmed over and over and over again by countless studies. Check into it a little and you'll find this information everywhere- well, except from your local hospital or OB/GYN).


Are there any extra risks to a hospital birth?


Studies have found that there are some problems that are more likely to occur in a hospital birth, such as the baby being born with a lower Apgar score (this is an assessment of the baby’s condition at birth). It is also more likely that the woman will have interventions such as an episiotomy (a cut in the vaginal entrance made just before birth), a drip to speed up labour, and drugs for pain. Also, infections in both mother and baby are more likely in hospital.


Women booked to have their baby at home are less likely to have a caesarean section, even if they need to transfer to hospital during their labour.


So, what does a midwife bring with her to a labor? Good question! This will vary in exactness by each midwife. Peggy Vincent gives her list in the back of her book, Baby Catcher, and I thought I'd share it with you:

Pitocin and Methergine
Syringes, needles, IV intercaths, and alcohol swabs
Ammonia ampoules, Ketostix, and Dextrostix
Penlight and scrub brush
Spare batteries for pager, Doppler, and penlight
Xylocaine and suture material
Cord clamps
Tubes for collecting cord blood
Infant airway and rescue blanket
Gloves (both sterile and non sterile) and KY Jelly
4x4 sterile gauze packets
Amnihooks
Big mirror
Baby scale and flannel sling
Sterile instruments:
2 Mayo clamps, 2 scissors, sponge stick, needle holder, pickups
IV setup and 2 bags of IV solution
Blood drawing supplies
Ambu bag
Box of utility gloves
Extra gloves, 4x4's, amnihooks, etc
Oxygen tank. Oxygen masks for mother and baby

When I talked to midwives and was trying to sort out who to use and whether to do a homebirth or not, what each midwife said was pretty much the same about hospital transfers. They all said that usually there are indications during labor that a transfer may be eminent (meaning the problems show themselves a while before it's a do or die situation) and VARY RARELY is it an emergent situation calling for a transfer. Perhaps this is why my midwife has delivered over 1000 babies and has not had one mother or baby fatality or one mother or baby permanently injured.

I also believe that God knows exactly how each labor will go. No one ever wants to lose a baby or a mother. It's devastating and I can't even imagine what it would be like. But let's be honest here folks, it's not just happening in homebirths and not at all at hospitals- it's happening MORE in US hospitals than in homebirths in the US and in other countries.

Messing with nature has consequences. It's foolish of us as women to think that we can take all sorts of drugs and interventions and have no side effects to us or the baby. Often those side effects are minor, and sometimes they are not.

It's ironic that American women (especially in Washington) are very keyed into all things 'natural' (which I think for the most part is fantastic). Organic foods, supplements, delayed or no vaccinations, cloth diapers, natural fiber clothes, "reduce, reuse, and recycle" campaigns, etc........yet we see no problem introducing our children to the world in a way that is anything but 'natural'. A natural birth to me not only speaks of the lack of pain killers as most people think 'natural birth' means, it also speaks to the ability of the mother and her baby to do what God created both of them to do and in the timeframe and way they want to do it. The same mothers that won't buy their kids anything but organic milk are sometimes the same ones that are first in line for induction ("I'm so sick of being pregnant!"), for epidurals ("I don't want any pain!"), washing off the natural vernix immediately, cutting the still pulsing and natural cord immediately, and wrapping their baby in a super tight blanket not allowing the needed skin to skin contact that is completely natural! Are you seeing the hypocrisy here a little bit?

As I've blogged about before there are black and white issues in life and there are gray areas. I believe this all falls into a gray area. I don't for a second think you are a bad mother or going to hell if you choose to have a medicated and/or hospital birth.

I mostly think that women just don't know details and important facts about all this. It's pretty easy to go into the store and choose organic grapes over non organic grapes- everything is laid out clearly and it's easy to decipher which is which. When it comes to having a baby it's not all so clear. The way our generation (and the one before us) knows how to do things is to have an ObGyn (who is a skilled and wonderful knife carrying surgeon, a la Grey's Anatomy), deliver in a hospital, have all the lab work they suggest we have and ultrasounds they see fit, etc. Most of us have no idea that there is a whole world and group of people here in the US doings this differently.

I feel passionately about all this because I wish I'd known it when I had Eliana. I wish I'd known that I could say no to things and that it was ok to ask questions. I wish when I hadn't felt a good 'fit' with my OB that I would've just switched to someone else. I thought that sitting in a crowded waiting room for anywhere from 30 minutes to 2 1/2 hours (often the lights were being turned off as we were still sitting and waiting to see the Dr) to see a Dr who as nice as she was, only had 5-20 minutes tops to spend with me, was how things had to be done. I never questioned any lab work or ultrasounds and I should have. I got a weird look from the nurse this time around when I declined HIV testing, but I would bet everything I have and both my feet that I don't have HIV. Why should I pay $100 for them to tell me what I already know?

All that said, my goal is not to alienate anyone or make enemies. I want to share information. When knowledge is spread a person then has their own freedom of choice with what to do with that information. Kind of like accepting Jesus as your Lord and Savior. I could tell someone everything I know about Jesus and what he's done for me until I'm blue in the face- but I know you can't argue someone into heaven! It's a heart issue. All I can do is share why it's important to me and why I feel the way I do and allow God to soften and speak to that person's heart.

I more than anything feel sadness for women who experience what I did in the hospital. Not judgement or anger, just sadness. I don't want any woman to feel the way that I did and to have the dignity and blessing of the birth she wanted stripped away from her. I believe you can have a hospital birth that you will look back on very fondly, but you have to be prepared ahead of time for that. A birth plan is a great idea (I love this site- http://www.birthplan.com/ ), a doula/parent/friend who knows your wishes and will stand up for you is also a great idea. Know the hospital policies and what is and is not allowed. Plan ahead! You can even let the person on the phone know you want a natural birth, or birthing tub, etc...when you call in that you're on your way to the hospital. That way they'll know which room and nurses would be best for you.

Keep in mind though that birth in a hospital is not without risk of the domino effect, especially when all the above mentioned medications are used.

It goes like this:


Induction is suggested or asked for. The mother is given synthetic prostaglandins if needed or just goes straight to synthetic oxytocins. Contraction pains from synthetic oxytocin are BRUTAL (I know!) and the mother feels she has no choice but to get an epidural. The epidural slows things down and more oxytocin is needed. The high levels of oxytocin make for a very difficult labor for the mom and baby (even if the mom can't feel it because of her epidural, the poor baby is feeling it!). The baby then shows signs of fetal distress. Cesarean is required and everyone makes the mother believe that the cesarean saved her baby's life since it was 'in distress'. She never even knows that the baby was only in distress because of the domino of hospital interventions and synthetic drugs.

Food for thought I guess.

Because this is a gray area it's important as women and especially Christian women to pray about it and really decide as a family what our convictions are on things. If you disagree with me on anything, that's fine, you're allowed to! There are many things that I don't agree with friends and other women/moms about and that's fine, too. A lot of this is my opinion. The most previous blog was more facts. Go ahead and disagree with and argue with me, but keep in mind the facts are not just my opinions, they're facts- don't hate the messenger :) I've learned through all the months of blogging that no matter what I post (breastfeeding, gardening, God, raising our children, cooking, etc), someone will be offended/mad/irritated/take it personally and on that exact same blog others will love it and totally agree. I can't please everyone and I sure as heck am not trying to.



So yes, things can happen at a homebirth. Just like they can happen at a hospital. Having an OR down the hall doesn't necessarily mean everyone will be ok, unfortunately. Every time we hear of a fatality no matter where it happened it's heartbreaking.

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